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

Research output: Contribution to journalArticleResearchpeer-review

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.

LanguageEnglish
Pages51-60
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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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.",
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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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T1 - High risk of Plasmodium vivax malaria following splenectomy in Papua, Indonesia

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

AU - Price, Ric

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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