Scripties UMCG - Rijksuniversiteit Groningen
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Risk factors for imported severe non-falciparum malaria

(2017) Verhoeff, A.

Malaria remains one of the most common and severe imported diseases. Plasmodium (P.) falciparum is responsible for most malaria deaths and is therefore considered as the most dangerous Plasmodium species. Non-falciparum malaria is likely to cause milder illness, however cases with severe and fatal outcome are reported.
The aim of this study was to assess in comparison with P. falciparum infections which proportion of non-falciparum infections is associated with a severe outcome and if there are predictors that are able to predict a worse outcome.
Between 1998 and 2016, 203 patients were diagnosed with non-falciparum malaria in the Harbour Hospital. Demographic, clinical and laboratory data of these patients were collected in the Rotterdam Malaria Cohort.
Severe outcome classified by the ‘2014 World Health Organization (WHO) severity criteria’ and according to ‘unfavourable outcome’ occurred less frequently in non-falciparum malaria patients (6.9% and 7.9% respectively) when compared to P. falciparum malaria patients (14.8% and 34.9% respectively). Various laboratory parameters (white blood cell count, platelet count, C-reactive protein (CRP), creatinine, lactate dehydrogenase (LDH), bilirubin and lactate levels) were most prominent in severe P. falciparum malaria, followed by severe non-falciparum malaria and non-severe malaria patients.
Univariate and multivariate statistical analysis showed that a thrombocyte count < 50 x 109/L on admission was an independent predictor for severe non-falciparum malaria as well as for an ‘unfavourable outcome’.

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