A Prospective Comparative Study of Knowlesi, Falciparum, and Vivax Malaria in Sabah, Malaysia: High Proportion With Severe Disease From Plasmodium Knowlesi and Plasmodium Vivax But No Mortality With Early Referral and Artesunate Therapy
A Prospective Comparative Study of Knowlesi, Falciparum, and Vivax Malaria in Sabah, Malaysia: High Proportion With Severe Disease From Plasmodium Knowlesi and Plasmodium Vivax But No Mortality With Early Referral and Artesunate Therapy
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DOI：
10.1093/cid/cis902
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发表时间：
2013-02-01
影响因子：
11.8
通讯作者：
Yeo, Tsin W.
中科院分区：
文献类型：
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作者：
Barber, Bridget E.;William, Timothy;Yeo, Tsin W.
背景诺氏疟原虫通常在马来西亚婆罗洲引起严重的疟疾，据报道病死率很高。我们比较了诺氏疟原虫、恶性疟原虫和间日疟原虫的严重疾病的风险、谱和结果，以及引入早期转诊和静脉注射青蒿琥酯治疗所有严重疟疾的方案后的结果。从2010年9月至2011年10月，我们前瞻性评估了沙巴伊丽莎白女王医院（QEH）收治的年龄≥ 12岁的非妊娠患者，这些患者经聚合酶链反应证实为疟原虫单一感染。在地区医院建立了规范的转诊和转诊前静脉注射青蒿琥酯。诺氏疟原虫感染者38/130例（29%），恶性疟原虫感染者13/122例（11%），间日疟原虫感染者7/43例（16%）。诺氏疟最常见的严重程度标准包括寄生虫血症> 10万/μ L（n = 18）、黄疸（n = 20）、呼吸窘迫（n = 14）、低血压（n = 13）和急性肾损伤（n = 9）。在多变量分析中，诺氏疟原虫与恶性疟原虫的2.96倍（95%置信区间，1.19-7.38倍）严重风险相关（P = 0.020）;只有寄生虫血症和血吸虫血症>10%独立预测诺氏疟原虫的严重性。当原虫血症>20 000/mu L时，严重诺氏疟疾的风险增加11倍，当原虫血症>100 000/mu L时，严重诺氏疟疾的风险增加28倍。几乎所有（92%）诺氏疟疾患者均接受口服青蒿素治疗; 38例重症和92例非重症患者中分别有36例（95%）和39例（42%）接受≥ 1剂静脉注射青蒿琥酯。没有发生任何物种的死亡。结论。诺氏疟原虫是QEH严重疟疾的最常见原因，寄生虫血症是严重程度的主要风险因素。早期转诊和青蒿琥酯治疗对所有物种的严重疟疾都非常有效，死亡率为零。
Background. Plasmodium knowlesi commonly causes severe malaria in Malaysian Borneo, with high case-fatality rates reported. We compared risk, spectrum, and outcome of severe disease from P. knowlesi, Plasmodium falciparum, and Plasmodium vivax and outcomes following introduction of protocols for early referral and intravenous artesunate for all severe malaria.Methods. From September 2010 to October 2011 we prospectively assessed nonpregnant patients aged >= 12 years admitted to Queen Elizabeth Hospital (QEH), Sabah, with polymerase chain reaction-confirmed Plasmodium monoinfection. Standardized referral and prereferral intravenous artesunate were instituted at district hospitals.Results. Severe malaria occurred in 38 of 130 (29%) patients with P. knowlesi, 13 of 122 (11%) with P. falciparum, and 7 of 43 (16%) with P. vivax. The commonest severity criteria in knowlesi malaria included parasitemia >100 000/mu L (n = 18), jaundice (n = 20), respiratory distress (n = 14), hypotension (n = 13), and acute kidney injury (n = 9). On multivariate analysis, P. knowlesi was associated with a 2.96-fold (95% confidence interval, 1.19-7.38-fold) greater risk of severity than P. falciparum (P = .020); only parasitemia and schizontemia >10% independently predicted knowlesi severity. Risk of severe knowlesi malaria increased 11-fold with parasitemia >20 000/mu L, and 28-fold with parasitemia >100 000/mu L. Nearly all (92%) knowlesi malaria patients received oral artemisinin therapy; 36 of 38 (95%) and 39 of 92 (42%) with severe and nonsevere disease, respectively, also received = 1 dose of intravenous artesunate. No deaths occurred from any species.Conclusions. Plasmodium knowlesi is the commonest cause of severe malaria at QEH, with parasitemia the major risk factor for severity. Early referral and treatment with artesunate was highly effective for severe malaria from all species and associated with zero mortality.