Not all severe malaria cases are severe: Is it time to redefine severity criteria for malaria in non-endemic regions?

BACKGROUND: The current definition of severe malaria in non-endemic areas follows WHO criteria, which mainly target children in malaria-endemic areas, potentially misclassifying cases in non-endemic regions. We assessed the performance of a modified severe malaria classification criteria within our patient cohort. METHODS: A cohort study of patients managed for malaria in a non-endemic setting (2005-2023) was analyzed. We classified patients into severe malaria (SM) using WHO 2013 criteria except for hyperparasitemia, where 2 % threshold was applied. Patients with SM were distinguished as very severe malaria (VSM) when presenting at least one of the following conditions: parasitemia >10 %, pulmonary edema, impaired consciousness, seizures, renal failure, metabolic acidosis or hyperlactatemia, shock or hypoglycemia. In patients with SM and no criteria for VSM, less severe malaria (LSM) was defined by: 2-10 % parasitemia, hyperbilirubinemia, prostration, anemia or minor bleeding. The primary composite outcome was death or the need for a life-saving intervention, as analyzed in the three comparative groups. Secondary outcome was the prevalence of co-infections. RESULTS: Among 506 patients with malaria, 176 (34.8 %) presented with SM. A total of 37 (7.3 %) patients developed a life-threatening condition, namely death (n = 4) and/or the need for life-saving interventions (n = 34). All fatalities and 33 out of the 34 life-saving interventions occurred in the VSM group. Patients in LSM group did not develop any life-threatening conditions. As to co-infections, 28 (5.5 %) patients had a community-acquired co-infection, with no differences between groups (p = 0.763). CONCLUSIONS: Severity criteria definitions would benefit from a review when assessing patients with malaria in non-endemic areas. Within the spectrum of SM, patients reclassified as LSM have a low risk of developing a life-threatening condition and present low co-infection incidence and could benefit from management out of intensive care units and a restrictive use of empirical antibiotics.

Estudio ecocardiografico de la persistencia del conducto arterioso (PCA) en neonatos de pretermino. / Echocardiographic study of the persistence of patent ductus arteriosus in preterm newborn infants

En 107 neonatos de pretermino se midio la relacion auricula izquierda/aorta (AI/AO) por medio de la ecocardiografia modo M. Se comprobo que los recien nacidos de pretermino afectados de persistencia del conducto arterioso (PCA) (42 pacientes) presentaron una relacion AI/AO mayor que la observada en los neonatos sin este padecimiento (57 pacientes). En cinco casos el, estudio ecocardiografico mostro la existencia de PCA antes de la aparicion de los sintomas clinicos. Los neonatos sin PCA presentaron en casi todos los casos una relacion AI/AO inferior a 1,0, mientras que los afectados de PCA tuvieron un valor promedio de la relacion AI/AO mayor de 1,20. En los neonatos de pretermino en los que se analizo la evolucion de la relacion AI/AO luego del tratamiento de la PCA, se observo una estrecha relacion entre el descenso de la relacion AI/AO y la mejoria clinica, aunque los cambios ecocardiograficos precedieron a la desaparicion completa de los signos clinicos de PCA