دورية أكاديمية
Not all severe malaria cases are severe: Is it time to redefine severity criteria for malaria in non-endemic regions?
| العنوان: | Not all severe malaria cases are severe: Is it time to redefine severity criteria for malaria in non-endemic regions? |
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| المؤلفون: | Balerdi-Sarasola L; ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain. Electronic address: leirebalerdisarasola@gmail.com., Muñoz J; ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain., Fleitas P; ISGlobal, Barcelona, Spain., Rodriguez-Valero N; ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain., Almuedo-Riera A; ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain., Antequera A; ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain., Subirà C; ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain., Grafia-Perez I; Medical Oncology Department, Hospital Clinic, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain., Ortiz-Fernández M; Internal Medicine Department, Hospital Clínic-Universitat de Barcelona, Spain., de Alba T; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain., Álvarez-Martínez MJ; ISGlobal, Barcelona, Spain; Microbiology Department, Hospital Clinic-Universitat de Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain., Valls ME; Microbiology Department, Hospital Clinic-Universitat de Barcelona, Spain., Parolo C; ISGlobal, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain., Castro P; Medical Intensive Care Unit, Hospital Clínic-Universitat de Barcelona, Spain., Camprubí-Ferrer D; ISGlobal, Barcelona, Spain; International Health Department, Hospital Clínic de Barcelona, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain. |
| المصدر: | Travel medicine and infectious disease [Travel Med Infect Dis] 2024 Jul 14; Vol. 60, pp. 102740. Date of Electronic Publication: 2024 Jul 14. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Science Country of Publication: Netherlands NLM ID: 101230758 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-0442 (Electronic) Linking ISSN: 14778939 NLM ISO Abbreviation: Travel Med Infect Dis Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Amsterdam : Elsevier Science, 2003- |
| مستخلص: | 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. Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Copyright © 2024. Published by Elsevier Ltd.) |
| فهرسة مساهمة: | Keywords: Imported malaria; Severe malaria; Travel medicine |
| تواريخ الأحداث: | Date Created: 20240713 Latest Revision: 20240719 |
| رمز التحديث: | 20240720 |
| DOI: | 10.1016/j.tmaid.2024.102740 |
| PMID: | 39002737 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1873-0442 |
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| DOI: | 10.1016/j.tmaid.2024.102740 |