High risk of Plasmodium vivax malaria following splenectomy in Papua, Indonesia

Steven Kho, Benediktus Andries, Robert James Commons, PAI Shanti , E. Kenangalem, Nicholas (Nick) Douglas, J. Simpson, Paulus Sugiarto, Nicholas Anstey, Ric Price

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    Abstract

    Background: Splenectomy increases the risk of severe and fatal infections; however, the risk of Plasmodium vivax malaria is unknown. We quantified the Plasmodium species-specific risks of malaria and other outcomes following splenectomy in patients attending a hospital in Papua, Indonesia.

    Methods: Records of all patients attending Mitra-Masyarakat Hospital 2004–2013 were reviewed, identifying those who underwent splenectomy. Subsequent risks of specific clinical outcomes within 12 months for splenectomized patients were compared to nonsplenectomized patients from their first recorded hospital admission. In addition, patients splenectomized for trauma 2015–2016 were followed prospectively for 14 months.

    Results: Of the 10774 patients hospitalized during 2004–2013, 67 underwent splenectomy. Compared to nonsplenectomized inpatients, patients undergoing splenectomy had a 5-fold higher rate of malaria presentation within 12 months (adjusted hazard ratio [AHR] = 5.0 [95% confidence interval (CI): 3.4–7.3], P < .001). The AHR was 7.8 (95% CI: 5.0–12.3) for P. vivax and 3.0 (95% CI: 1.7–5.4) for P. falciparum (both P < .001). Splenectomized patients had greater risk of being hospitalized for any cause (AHR = 1.8 [95% CI: 1.0–3.0], P = .037) and diarrheal (AHR = 3.5 [95% CI: 1.3–9.6], P = .016). In the 14-month prospective cohort, 12 episodes of P. vivax and 6 episodes of P. falciparum were observed in 11 splenectomised patients.

    Conclusions: Splenectomy is associated with a high risk of malaria, greater for P. vivax than P. falciparum. Eradication of P. vivax hypnozoites using primaquine (radical cure) and subsequent malaria prophylaxis is warranted following splenectomy in malaria-endemic areas.

    Original languageEnglish
    Pages (from-to)51-60
    Number of pages10
    JournalClinical Infectious Diseases
    Volume68
    Issue number1
    Early online date16 May 2018
    DOIs
    Publication statusPublished - 1 Jan 2019

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    Vivax Malaria
    Indonesia
    Splenectomy
    Confidence Intervals
    Malaria
    Plasmodium vivax
    Inpatients
    Primaquine
    Wounds and Injuries

    Cite this

    Kho, S., Andries, B., Commons, R. J., Shanti , PAI., Kenangalem, E., Douglas, N. N., ... Price, R. (2019). High risk of Plasmodium vivax malaria following splenectomy in Papua, Indonesia. Clinical Infectious Diseases, 68(1), 51-60. https://doi.org/10.1093/cid/ciy403
    Kho, Steven ; Andries, Benediktus ; Commons, Robert James ; Shanti , PAI ; Kenangalem, E. ; Douglas, Nicholas (Nick) ; Simpson, J. ; Sugiarto, Paulus ; Anstey, Nicholas ; Price, Ric. / High risk of Plasmodium vivax malaria following splenectomy in Papua, Indonesia. In: Clinical Infectious Diseases. 2019 ; Vol. 68, No. 1. pp. 51-60.
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    title = "High risk of Plasmodium vivax malaria following splenectomy in Papua, Indonesia",
    abstract = "Background: Splenectomy increases the risk of severe and fatal infections; however, the risk of Plasmodium vivax malaria is unknown. We quantified the Plasmodium species-specific risks of malaria and other outcomes following splenectomy in patients attending a hospital in Papua, Indonesia. Methods: Records of all patients attending Mitra-Masyarakat Hospital 2004–2013 were reviewed, identifying those who underwent splenectomy. Subsequent risks of specific clinical outcomes within 12 months for splenectomized patients were compared to nonsplenectomized patients from their first recorded hospital admission. In addition, patients splenectomized for trauma 2015–2016 were followed prospectively for 14 months. Results: Of the 10774 patients hospitalized during 2004–2013, 67 underwent splenectomy. Compared to nonsplenectomized inpatients, patients undergoing splenectomy had a 5-fold higher rate of malaria presentation within 12 months (adjusted hazard ratio [AHR] = 5.0 [95{\%} confidence interval (CI): 3.4–7.3], P < .001). The AHR was 7.8 (95{\%} CI: 5.0–12.3) for P. vivax and 3.0 (95{\%} CI: 1.7–5.4) for P. falciparum (both P < .001). Splenectomized patients had greater risk of being hospitalized for any cause (AHR = 1.8 [95{\%} CI: 1.0–3.0], P = .037) and diarrheal (AHR = 3.5 [95{\%} CI: 1.3–9.6], P = .016). In the 14-month prospective cohort, 12 episodes of P. vivax and 6 episodes of P. falciparum were observed in 11 splenectomised patients. Conclusions: Splenectomy is associated with a high risk of malaria, greater for P. vivax than P. falciparum. Eradication of P. vivax hypnozoites using primaquine (radical cure) and subsequent malaria prophylaxis is warranted following splenectomy in malaria-endemic areas.",
    author = "Steven Kho and Benediktus Andries and Commons, {Robert James} and PAI Shanti and E. Kenangalem and Douglas, {Nicholas (Nick)} and J. Simpson and Paulus Sugiarto and Nicholas Anstey and Ric Price",
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    Kho, S, Andries, B, Commons, RJ, Shanti , PAI, Kenangalem, E, Douglas, NN, Simpson, J, Sugiarto, P, Anstey, N & Price, R 2019, 'High risk of Plasmodium vivax malaria following splenectomy in Papua, Indonesia', Clinical Infectious Diseases, vol. 68, no. 1, pp. 51-60. https://doi.org/10.1093/cid/ciy403

    High risk of Plasmodium vivax malaria following splenectomy in Papua, Indonesia. / Kho, Steven; Andries, Benediktus; Commons, Robert James; Shanti , PAI; Kenangalem, E.; Douglas, Nicholas (Nick); Simpson, J.; Sugiarto, Paulus; Anstey, Nicholas; Price, Ric.

    In: Clinical Infectious Diseases, Vol. 68, No. 1, 01.01.2019, p. 51-60.

    Research output: Contribution to journalArticleResearchpeer-review

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    AU - Kho, Steven

    AU - Andries, Benediktus

    AU - Commons, Robert James

    AU - Shanti , PAI

    AU - Kenangalem, E.

    AU - Douglas, Nicholas (Nick)

    AU - Simpson, J.

    AU - Sugiarto, Paulus

    AU - Anstey, Nicholas

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    N2 - Background: Splenectomy increases the risk of severe and fatal infections; however, the risk of Plasmodium vivax malaria is unknown. We quantified the Plasmodium species-specific risks of malaria and other outcomes following splenectomy in patients attending a hospital in Papua, Indonesia. Methods: Records of all patients attending Mitra-Masyarakat Hospital 2004–2013 were reviewed, identifying those who underwent splenectomy. Subsequent risks of specific clinical outcomes within 12 months for splenectomized patients were compared to nonsplenectomized patients from their first recorded hospital admission. In addition, patients splenectomized for trauma 2015–2016 were followed prospectively for 14 months. Results: Of the 10774 patients hospitalized during 2004–2013, 67 underwent splenectomy. Compared to nonsplenectomized inpatients, patients undergoing splenectomy had a 5-fold higher rate of malaria presentation within 12 months (adjusted hazard ratio [AHR] = 5.0 [95% confidence interval (CI): 3.4–7.3], P < .001). The AHR was 7.8 (95% CI: 5.0–12.3) for P. vivax and 3.0 (95% CI: 1.7–5.4) for P. falciparum (both P < .001). Splenectomized patients had greater risk of being hospitalized for any cause (AHR = 1.8 [95% CI: 1.0–3.0], P = .037) and diarrheal (AHR = 3.5 [95% CI: 1.3–9.6], P = .016). In the 14-month prospective cohort, 12 episodes of P. vivax and 6 episodes of P. falciparum were observed in 11 splenectomised patients. Conclusions: Splenectomy is associated with a high risk of malaria, greater for P. vivax than P. falciparum. Eradication of P. vivax hypnozoites using primaquine (radical cure) and subsequent malaria prophylaxis is warranted following splenectomy in malaria-endemic areas.

    AB - Background: Splenectomy increases the risk of severe and fatal infections; however, the risk of Plasmodium vivax malaria is unknown. We quantified the Plasmodium species-specific risks of malaria and other outcomes following splenectomy in patients attending a hospital in Papua, Indonesia. Methods: Records of all patients attending Mitra-Masyarakat Hospital 2004–2013 were reviewed, identifying those who underwent splenectomy. Subsequent risks of specific clinical outcomes within 12 months for splenectomized patients were compared to nonsplenectomized patients from their first recorded hospital admission. In addition, patients splenectomized for trauma 2015–2016 were followed prospectively for 14 months. Results: Of the 10774 patients hospitalized during 2004–2013, 67 underwent splenectomy. Compared to nonsplenectomized inpatients, patients undergoing splenectomy had a 5-fold higher rate of malaria presentation within 12 months (adjusted hazard ratio [AHR] = 5.0 [95% confidence interval (CI): 3.4–7.3], P < .001). The AHR was 7.8 (95% CI: 5.0–12.3) for P. vivax and 3.0 (95% CI: 1.7–5.4) for P. falciparum (both P < .001). Splenectomized patients had greater risk of being hospitalized for any cause (AHR = 1.8 [95% CI: 1.0–3.0], P = .037) and diarrheal (AHR = 3.5 [95% CI: 1.3–9.6], P = .016). In the 14-month prospective cohort, 12 episodes of P. vivax and 6 episodes of P. falciparum were observed in 11 splenectomised patients. Conclusions: Splenectomy is associated with a high risk of malaria, greater for P. vivax than P. falciparum. Eradication of P. vivax hypnozoites using primaquine (radical cure) and subsequent malaria prophylaxis is warranted following splenectomy in malaria-endemic areas.

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    Kho S, Andries B, Commons RJ, Shanti PAI, Kenangalem E, Douglas NN et al. High risk of Plasmodium vivax malaria following splenectomy in Papua, Indonesia. Clinical Infectious Diseases. 2019 Jan 1;68(1):51-60. https://doi.org/10.1093/cid/ciy403