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Title: Age-Related Clinical Spectrum of Plasmodium knowlesi Malaria and Predictors of Severity.
Authors: Grigg, Matthew J
William, Timothy
Barber, Bridget E
Rajahram, Giri S
Menon, Jayaram
Schimann, Emma
Piera, Kim
Wilkes, Christopher S
Patel, Kaajal
Chandna, Arjun
Drakeley, Christopher J
Yeo, Tsin W
Anstey, Nicholas M
Citation: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2018-07-18; 67(3): 350-359
Abstract: Plasmodium knowlesi is increasingly reported in Southeast Asia, but prospective studies of its clinical spectrum in children and comparison with autochthonous human-only Plasmodium species are lacking. Over 3.5 years, we prospectively assessed patients of any age with molecularly-confirmed Plasmodium monoinfection presenting to 3 district hospitals in Sabah, Malaysia. Of 481 knowlesi, 172 vivax, and 96 falciparum malaria cases enrolled, 44 (9%), 71 (41%), and 31 (32%) children aged ≤12 years. Median parasitemia was lower in knowlesi malaria (2480/μL [interquartile range, 538-8481/μL]) than in falciparum (9600/μL; P < .001) and vivax malaria. In P. knowlesi, World Health Organization-defined anemia was present in 82% (95% confidence interval [CI], 67%-92%) of children vs 36% (95% CI, 31%-41%) of adults. Severe knowlesi malaria occurred in 6.4% (95% CI, 3.9%-8.3%) of adults but not in children; the commenst severity criterion was acute kideny injury. No patient had coma. Age, parasitemia, schizont proportion, abdominal pain, and dyspnea were independently associated with severe knowlesi malaria, with parasitemia >15000/μL the best predictor (adjusted odds ratio, 16.1; negative predictive value, 98.5%; P < .001). Two knowlesi-related adult deaths occurred (fatality rate: 4.2/1000 adults). Age distribution and parasitemia differed markedly in knowlesi malaria compared to human-only species, with both uncomplicated and severe disease occurring at low parasitemia. Severe knowlesi malaria occurred only in adults; however, anemia was more common in children despite lower parasitemia. Parasitemia independently predicted knowlesi disease severity: Intravenous artesunate is warranted initially for those with parasitemia >15000/μL.
Click to open PubMed article: https://www.ezpdhcs.nt.gov.au/login?url=https://www.ncbi.nlm.nih.gov/pubmed/29873683
Click to open Pubmed Article: https://www.ezpdhcs.nt.gov.au/login?url=https://www.ncbi.nlm.nih.gov/pubmed/29873683
Journal title: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Publication Date: 2018-07-18
Type: Journal Article
URI: https://hdl.handle.net/10137/7034
DOI: 10.1093/cid/ciy065
Appears in Collections:(a) NT Health Research Collection

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