Laboratory markers of disease severity in Plasmodium knowlesi infection: a case control study

Autor: Sanjeev Krishna, Atique Ahmed, Janet Cox-Singh, Matthias Willmann, Balbir Singh, Angela Siner, Lu Chan Woon, Ing Tien Wong
Přispěvatelé: University of St Andrews. School of Medicine, University of St Andrews. Infection Group, University of St Andrews. Biomedical Sciences Research Complex
Jazyk: angličtina
Rok vydání: 2012
Předmět:
Male
Platelet count
Neutrophils
Parasitemia
Parasite load
Severity of Illness Index
Parasite Load
Leukocyte Count
0302 clinical medicine
Borneo
030212 general & internal medicine
Children
Parasitaemia
Containing Leukocytes
Middle Aged
Thailand
3. Good health
Infectious Diseases
Plasmodium knowlesi
Female
Malaria pigment
Adult
Hemeproteins
medicine.medical_specialty
lcsh:Arctic medicine. Tropical medicine
lcsh:RC955-962
030231 tropical medicine
Biology
R Medicine
Models
Biological
lcsh:Infectious and parasitic diseases
Association
Haemozoin
03 medical and health sciences
SDG 3 - Good Health and Well-being
Internal medicine
Severity of illness
parasitic diseases
medicine
Humans
lcsh:RC109-216
Receiver operating characteristic
Research
Odds ratio
Pigments
Biological
medicine.disease
biology.organism_classification
Severity markers
Confidence interval
Malaria
Case-Control Studies
Immunology
Parasitology
Biomarkers
Zdroj: Malaria Journal
Malaria Journal, Vol 11, Iss 1, p 363 (2012)
ISSN: 1475-2875
Popis: Background Plasmodium knowlesi malaria causes severe disease in up to 10% of cases in Malaysian Borneo and has a mortality rate of 1 - 2%. However, laboratory markers with the ability to identify patients at risk of developing complications have not yet been assessed as they have for other species of Plasmodium. Methods A case control study was undertaken in two hospitals in Sarikei and Sibu, Malaysian Borneo. One hundred and ten patients with uncomplicated (n = 93) and severe (n = 17) P. knowlesi malaria were studied. Standardized pigment-containing neutrophil (PCN) count, parasite density and platelet counts were determined and analysed by logistic regression and receiver operating characteristic (ROC) analysis. Results The PCN count was strongly associated with risk of disease severity. Patients with high parasite density (≥ 35,000/μl) or with thrombocytopaenia (≤ 45,000/μl) were also more likely to develop complications (odds ratio (OR) = 9.93 and OR = 5.27, respectively). The PCN count yielded the highest area under the ROC curve (AUC) estimate among all markers of severity (AUC = 0.8561, 95% confidence interval: 0.7328, 0.9794). However, the difference between all parameter AUC estimates was not statistically significant (Wald test, p = 0.73). Conclusion Counting PCN is labour-intensive and not superior in predicting severity over parasitaemia and platelet counts. Parasite and platelet counts are simpler tests with an acceptable degree of precision. Any adult patient diagnosed with P. knowlesi malaria and having a parasite count ≥35,000/μl or ≥1% or a platelet count ≤45,000/μl can be regarded at risk of developing complications and should be managed according to current WHO guidelines for the treatment of severe malaria.
Databáze: OpenAIRE
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