Diagnosis, clinical presentation, and in-hospital mortality of severe malaria in HIV-coinfected children and adults in Mozambique

Ilse Hendriksen, Josefo Ferro, Pablo Montoya, Kajal D Chhaganlal, Amir Seni, Ermelinda Gomes, Kamolrat Silamut, Sue J Lee, G Marcelino E S Lucas, Kesinee Chotivanich, Caterina Fanello, N Day, Nicholas J White, Lorenz Von Seidlein, Arjen Dondorp

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Severe falciparum malaria with human immunodeficiency virus (HIV) coinfection is common in settings with a high prevalence of both diseases, but there is little information on whether HIV affects the clinical presentation and outcome of severe malaria.

Methods: HIV status was assessed prospectively in hospitalized parasitemic adults and children with severe malaria in Beira, Mozambique, as part of a clinical trial comparing parenteral artesunate versus quinine (ISRCTN50258054). Clinical signs, comorbidity, complications, and disease outcome were compared according to HIV status.

Results: HIV-1 seroprevalence was 11 (74/655) in children under 15 years and 72 (49/68) in adults with severe malaria. Children with HIV coinfection presented with more severe acidosis, anemia, and respiratory distress, and higher peripheral blood parasitemia and plasma Plasmodium falciparum histidine-rich protein-2 (PfHRP2). During hospitalization, deterioration in coma score, convulsions, respiratory distress, and pneumonia were more common in HIV-coinfected children, and mortality was 26 (19/74) versus 9 (53/581) in uninfected children (P <. 001). In an age-and antimalarial treatment-adjusted logistic regression model, significant, independent predictors for death were renal impairment, acidosis, parasitemia, and plasma PfHRP2 concentration. 

Conclusions: Severe malaria in HIV-coinfected patients presents with higher parasite burden, more complications, and comorbidity, and carries a higher case fatality rate. Early identification of HIV coinfection is important for the clinical management of severe malaria. 
Original languageEnglish
Pages (from-to)1144-1153
Number of pages10
JournalClinical Infectious Diseases
Volume55
Issue number8
DOIs
Publication statusPublished - 15 Oct 2012

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Mozambique
Hospital Mortality
Malaria
HIV
Coinfection
Parasitemia
Plasmodium falciparum
Comorbidity
Logistic Models
Respiratory Acidosis
Child Mortality
Quinine
Falciparum Malaria
Seroepidemiologic Studies
Antimalarials
Cerebral Palsy
Coma
Acidosis
HIV-1
Anemia

Cite this

Hendriksen, Ilse ; Ferro, Josefo ; Montoya, Pablo ; Chhaganlal, Kajal D ; Seni, Amir ; Gomes, Ermelinda ; Silamut, Kamolrat ; Lee, Sue J ; Lucas, G Marcelino E S ; Chotivanich, Kesinee ; Fanello, Caterina ; Day, N ; White, Nicholas J ; Von Seidlein, Lorenz ; Dondorp, Arjen. / Diagnosis, clinical presentation, and in-hospital mortality of severe malaria in HIV-coinfected children and adults in Mozambique. In: Clinical Infectious Diseases. 2012 ; Vol. 55, No. 8. pp. 1144-1153.
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abstract = "Background: Severe falciparum malaria with human immunodeficiency virus (HIV) coinfection is common in settings with a high prevalence of both diseases, but there is little information on whether HIV affects the clinical presentation and outcome of severe malaria.Methods: HIV status was assessed prospectively in hospitalized parasitemic adults and children with severe malaria in Beira, Mozambique, as part of a clinical trial comparing parenteral artesunate versus quinine (ISRCTN50258054). Clinical signs, comorbidity, complications, and disease outcome were compared according to HIV status.Results: HIV-1 seroprevalence was 11 (74/655) in children under 15 years and 72 (49/68) in adults with severe malaria. Children with HIV coinfection presented with more severe acidosis, anemia, and respiratory distress, and higher peripheral blood parasitemia and plasma Plasmodium falciparum histidine-rich protein-2 (PfHRP2). During hospitalization, deterioration in coma score, convulsions, respiratory distress, and pneumonia were more common in HIV-coinfected children, and mortality was 26 (19/74) versus 9 (53/581) in uninfected children (P <. 001). In an age-and antimalarial treatment-adjusted logistic regression model, significant, independent predictors for death were renal impairment, acidosis, parasitemia, and plasma PfHRP2 concentration. Conclusions: Severe malaria in HIV-coinfected patients presents with higher parasite burden, more complications, and comorbidity, and carries a higher case fatality rate. Early identification of HIV coinfection is important for the clinical management of severe malaria. ",
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Hendriksen, I, Ferro, J, Montoya, P, Chhaganlal, KD, Seni, A, Gomes, E, Silamut, K, Lee, SJ, Lucas, GMES, Chotivanich, K, Fanello, C, Day, N, White, NJ, Von Seidlein, L & Dondorp, A 2012, 'Diagnosis, clinical presentation, and in-hospital mortality of severe malaria in HIV-coinfected children and adults in Mozambique', Clinical Infectious Diseases, vol. 55, no. 8, pp. 1144-1153. https://doi.org/10.1093/cid/cis590

Diagnosis, clinical presentation, and in-hospital mortality of severe malaria in HIV-coinfected children and adults in Mozambique. / Hendriksen, Ilse; Ferro, Josefo; Montoya, Pablo; Chhaganlal, Kajal D; Seni, Amir; Gomes, Ermelinda; Silamut, Kamolrat; Lee, Sue J; Lucas, G Marcelino E S; Chotivanich, Kesinee; Fanello, Caterina; Day, N; White, Nicholas J; Von Seidlein, Lorenz; Dondorp, Arjen.

In: Clinical Infectious Diseases, Vol. 55, No. 8, 15.10.2012, p. 1144-1153.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Diagnosis, clinical presentation, and in-hospital mortality of severe malaria in HIV-coinfected children and adults in Mozambique

AU - Hendriksen, Ilse

AU - Ferro, Josefo

AU - Montoya, Pablo

AU - Chhaganlal, Kajal D

AU - Seni, Amir

AU - Gomes, Ermelinda

AU - Silamut, Kamolrat

AU - Lee, Sue J

AU - Lucas, G Marcelino E S

AU - Chotivanich, Kesinee

AU - Fanello, Caterina

AU - Day, N

AU - White, Nicholas J

AU - Von Seidlein, Lorenz

AU - Dondorp, Arjen

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Y1 - 2012/10/15

N2 - Background: Severe falciparum malaria with human immunodeficiency virus (HIV) coinfection is common in settings with a high prevalence of both diseases, but there is little information on whether HIV affects the clinical presentation and outcome of severe malaria.Methods: HIV status was assessed prospectively in hospitalized parasitemic adults and children with severe malaria in Beira, Mozambique, as part of a clinical trial comparing parenteral artesunate versus quinine (ISRCTN50258054). Clinical signs, comorbidity, complications, and disease outcome were compared according to HIV status.Results: HIV-1 seroprevalence was 11 (74/655) in children under 15 years and 72 (49/68) in adults with severe malaria. Children with HIV coinfection presented with more severe acidosis, anemia, and respiratory distress, and higher peripheral blood parasitemia and plasma Plasmodium falciparum histidine-rich protein-2 (PfHRP2). During hospitalization, deterioration in coma score, convulsions, respiratory distress, and pneumonia were more common in HIV-coinfected children, and mortality was 26 (19/74) versus 9 (53/581) in uninfected children (P <. 001). In an age-and antimalarial treatment-adjusted logistic regression model, significant, independent predictors for death were renal impairment, acidosis, parasitemia, and plasma PfHRP2 concentration. Conclusions: Severe malaria in HIV-coinfected patients presents with higher parasite burden, more complications, and comorbidity, and carries a higher case fatality rate. Early identification of HIV coinfection is important for the clinical management of severe malaria. 

AB - Background: Severe falciparum malaria with human immunodeficiency virus (HIV) coinfection is common in settings with a high prevalence of both diseases, but there is little information on whether HIV affects the clinical presentation and outcome of severe malaria.Methods: HIV status was assessed prospectively in hospitalized parasitemic adults and children with severe malaria in Beira, Mozambique, as part of a clinical trial comparing parenteral artesunate versus quinine (ISRCTN50258054). Clinical signs, comorbidity, complications, and disease outcome were compared according to HIV status.Results: HIV-1 seroprevalence was 11 (74/655) in children under 15 years and 72 (49/68) in adults with severe malaria. Children with HIV coinfection presented with more severe acidosis, anemia, and respiratory distress, and higher peripheral blood parasitemia and plasma Plasmodium falciparum histidine-rich protein-2 (PfHRP2). During hospitalization, deterioration in coma score, convulsions, respiratory distress, and pneumonia were more common in HIV-coinfected children, and mortality was 26 (19/74) versus 9 (53/581) in uninfected children (P <. 001). In an age-and antimalarial treatment-adjusted logistic regression model, significant, independent predictors for death were renal impairment, acidosis, parasitemia, and plasma PfHRP2 concentration. Conclusions: Severe malaria in HIV-coinfected patients presents with higher parasite burden, more complications, and comorbidity, and carries a higher case fatality rate. Early identification of HIV coinfection is important for the clinical management of severe malaria. 

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