Plasmodium Knowlesi Malaria in Children in Malaysia

No Severe Disease Despite an Increased Risk of Anaemia Compared to Adults

M. J. Grigg, T. William, B. E. Barber, G. S. Rajahram, J. Menon, C. S. Wilkes, K. Patel, A. Chandna, C. J. Drakeley, T. W. Yeo, N. M. Anstey

    Research output: Contribution to journalMeeting AbstractResearch

    Abstract

    Plasmodium knowlesi is now the most common cause of malaria in Malaysia, but prospective studies describing the clinical spectrum have only detailed adult disease. In our prospective study (2012-ongoing) at 3 district hospitals in Sabah, Malaysia, previously untreated, non-pregnant patients of any age hospitalised with PCR-confirmed malaria includes: 500 P. knowlesi (49 [9.8%] children 12 yrs), 204 P. vivax (83 [40.7%] children), 103 P. falciparum (33 [32%] children), 26 P. malariae, 1 mixed Pk/Pf and 1 mixed Pv/Pf. Preliminary data include a lower baseline parasite count for P. knowlesi malaria patients (median 2480/μL, IQR 538-8481) than P. falciparum (9600/μL [IQR 1446-25440]; p<0.001), and P. vivax (3882/μL, [1454-9608]; p=0.016). Parasite counts were higher in adults with P. knowlesi compared to children (median 2800 vs. 1535/μL; p=0.019). Anaemia (WHO criteria) was present in 32% (95%CI 27-36) of adults vs. 81% (95%CI 70-93) of children with knowlesi malaria (p<0.001); comparable to that seen in children with P. vivax (82%; p=0.948) or P. falciparum (76%; p=0.551). Acute kidney injury (AKIN criteria and/or creatinine >132mmol/L) was found in 26% (95% CI 22-30) of those with P. knowlesi malaria including 111/437 (25%) of adults and 13/46 (26%) of children (p=0.673). There was a higher prevalence of acute kidney injury in children with P. knowlesi malaria (26%) compared to P. vivax(12.5%; p=0.027) but not P. falciparum (30.3%; p=0.844). Severe malaria (modified WHO 2010 criteria) was present in 6.4% (95%CI 2.4-9.6%) of those with P. knowlesi overall: 32/451 (7.1%) in adults but none in children. In comparison, severe disease was seen in 6/204 (2.9%; p=0.065) with P. vivax and 4/103 (3.9%; p=0.326) with P. falciparum. There were no treatment failures in knowlesi malaria patients seen at 28 days. There was one P. knowlesi malaria death, an adult (age 62) with delayed parenteral artesunate due to misreported hyperparasitaemia. Overall P. knowlesimalaria predominantly affected adults, and while anaemia was more common in children, parasitemia was lower and severe disease was not seen.
    Original languageEnglish
    Article number 651
    Pages (from-to)205-205
    Number of pages1
    JournalAmerican Journal of Tropical Medicine and Hygiene
    Volume95
    Issue numberSuppl. 5
    DOIs
    Publication statusPublished - Mar 2017
    Event65th Annual Meeting of the American-Society-of-Tropical-Medicine-and-Hygiene (ASTMH) - Atlanta, United States
    Duration: 13 Nov 201616 Nov 2016

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    Plasmodium knowlesi
    Plasmodium malariae
    Malaysia
    Anemia
    Malaria
    Prospective Studies
    Parasitemia
    District Hospitals
    Treatment Failure
    Acute Kidney Injury
    Parasites
    Polymerase Chain Reaction

    Cite this

    Grigg, M. J. ; William, T. ; Barber, B. E. ; Rajahram, G. S. ; Menon, J. ; Wilkes, C. S. ; Patel, K. ; Chandna, A. ; Drakeley, C. J. ; Yeo, T. W. ; Anstey, N. M. / Plasmodium Knowlesi Malaria in Children in Malaysia : No Severe Disease Despite an Increased Risk of Anaemia Compared to Adults. In: American Journal of Tropical Medicine and Hygiene. 2017 ; Vol. 95, No. Suppl. 5. pp. 205-205.
    @article{d3963859377e498cbd8752efcb558387,
    title = "Plasmodium Knowlesi Malaria in Children in Malaysia: No Severe Disease Despite an Increased Risk of Anaemia Compared to Adults",
    abstract = "Plasmodium knowlesi is now the most common cause of malaria in Malaysia, but prospective studies describing the clinical spectrum have only detailed adult disease. In our prospective study (2012-ongoing) at 3 district hospitals in Sabah, Malaysia, previously untreated, non-pregnant patients of any age hospitalised with PCR-confirmed malaria includes: 500 P. knowlesi (49 [9.8{\%}] children 12 yrs), 204 P. vivax (83 [40.7{\%}] children), 103 P. falciparum (33 [32{\%}] children), 26 P. malariae, 1 mixed Pk/Pf and 1 mixed Pv/Pf. Preliminary data include a lower baseline parasite count for P. knowlesi malaria patients (median 2480/μL, IQR 538-8481) than P. falciparum (9600/μL [IQR 1446-25440]; p<0.001), and P. vivax (3882/μL, [1454-9608]; p=0.016). Parasite counts were higher in adults with P. knowlesi compared to children (median 2800 vs. 1535/μL; p=0.019). Anaemia (WHO criteria) was present in 32{\%} (95{\%}CI 27-36) of adults vs. 81{\%} (95{\%}CI 70-93) of children with knowlesi malaria (p<0.001); comparable to that seen in children with P. vivax (82{\%}; p=0.948) or P. falciparum (76{\%}; p=0.551). Acute kidney injury (AKIN criteria and/or creatinine >132mmol/L) was found in 26{\%} (95{\%} CI 22-30) of those with P. knowlesi malaria including 111/437 (25{\%}) of adults and 13/46 (26{\%}) of children (p=0.673). There was a higher prevalence of acute kidney injury in children with P. knowlesi malaria (26{\%}) compared to P. vivax(12.5{\%}; p=0.027) but not P. falciparum (30.3{\%}; p=0.844). Severe malaria (modified WHO 2010 criteria) was present in 6.4{\%} (95{\%}CI 2.4-9.6{\%}) of those with P. knowlesi overall: 32/451 (7.1{\%}) in adults but none in children. In comparison, severe disease was seen in 6/204 (2.9{\%}; p=0.065) with P. vivax and 4/103 (3.9{\%}; p=0.326) with P. falciparum. There were no treatment failures in knowlesi malaria patients seen at 28 days. There was one P. knowlesi malaria death, an adult (age 62) with delayed parenteral artesunate due to misreported hyperparasitaemia. Overall P. knowlesimalaria predominantly affected adults, and while anaemia was more common in children, parasitemia was lower and severe disease was not seen.",
    keywords = "Public, Environmental & Occupational Health Tropical Medicine",
    author = "Grigg, {M. J.} and T. William and Barber, {B. E.} and Rajahram, {G. S.} and J. Menon and Wilkes, {C. S.} and K. Patel and A. Chandna and Drakeley, {C. J.} and Yeo, {T. W.} and Anstey, {N. M.}",
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    Plasmodium Knowlesi Malaria in Children in Malaysia : No Severe Disease Despite an Increased Risk of Anaemia Compared to Adults. / Grigg, M. J.; William, T.; Barber, B. E.; Rajahram, G. S.; Menon, J.; Wilkes, C. S.; Patel, K.; Chandna, A.; Drakeley, C. J.; Yeo, T. W.; Anstey, N. M.

    In: American Journal of Tropical Medicine and Hygiene, Vol. 95, No. Suppl. 5, 651, 03.2017, p. 205-205.

    Research output: Contribution to journalMeeting AbstractResearch

    TY - JOUR

    T1 - Plasmodium Knowlesi Malaria in Children in Malaysia

    T2 - No Severe Disease Despite an Increased Risk of Anaemia Compared to Adults

    AU - Grigg, M. J.

    AU - William, T.

    AU - Barber, B. E.

    AU - Rajahram, G. S.

    AU - Menon, J.

    AU - Wilkes, C. S.

    AU - Patel, K.

    AU - Chandna, A.

    AU - Drakeley, C. J.

    AU - Yeo, T. W.

    AU - Anstey, N. M.

    PY - 2017/3

    Y1 - 2017/3

    N2 - Plasmodium knowlesi is now the most common cause of malaria in Malaysia, but prospective studies describing the clinical spectrum have only detailed adult disease. In our prospective study (2012-ongoing) at 3 district hospitals in Sabah, Malaysia, previously untreated, non-pregnant patients of any age hospitalised with PCR-confirmed malaria includes: 500 P. knowlesi (49 [9.8%] children 12 yrs), 204 P. vivax (83 [40.7%] children), 103 P. falciparum (33 [32%] children), 26 P. malariae, 1 mixed Pk/Pf and 1 mixed Pv/Pf. Preliminary data include a lower baseline parasite count for P. knowlesi malaria patients (median 2480/μL, IQR 538-8481) than P. falciparum (9600/μL [IQR 1446-25440]; p<0.001), and P. vivax (3882/μL, [1454-9608]; p=0.016). Parasite counts were higher in adults with P. knowlesi compared to children (median 2800 vs. 1535/μL; p=0.019). Anaemia (WHO criteria) was present in 32% (95%CI 27-36) of adults vs. 81% (95%CI 70-93) of children with knowlesi malaria (p<0.001); comparable to that seen in children with P. vivax (82%; p=0.948) or P. falciparum (76%; p=0.551). Acute kidney injury (AKIN criteria and/or creatinine >132mmol/L) was found in 26% (95% CI 22-30) of those with P. knowlesi malaria including 111/437 (25%) of adults and 13/46 (26%) of children (p=0.673). There was a higher prevalence of acute kidney injury in children with P. knowlesi malaria (26%) compared to P. vivax(12.5%; p=0.027) but not P. falciparum (30.3%; p=0.844). Severe malaria (modified WHO 2010 criteria) was present in 6.4% (95%CI 2.4-9.6%) of those with P. knowlesi overall: 32/451 (7.1%) in adults but none in children. In comparison, severe disease was seen in 6/204 (2.9%; p=0.065) with P. vivax and 4/103 (3.9%; p=0.326) with P. falciparum. There were no treatment failures in knowlesi malaria patients seen at 28 days. There was one P. knowlesi malaria death, an adult (age 62) with delayed parenteral artesunate due to misreported hyperparasitaemia. Overall P. knowlesimalaria predominantly affected adults, and while anaemia was more common in children, parasitemia was lower and severe disease was not seen.

    AB - Plasmodium knowlesi is now the most common cause of malaria in Malaysia, but prospective studies describing the clinical spectrum have only detailed adult disease. In our prospective study (2012-ongoing) at 3 district hospitals in Sabah, Malaysia, previously untreated, non-pregnant patients of any age hospitalised with PCR-confirmed malaria includes: 500 P. knowlesi (49 [9.8%] children 12 yrs), 204 P. vivax (83 [40.7%] children), 103 P. falciparum (33 [32%] children), 26 P. malariae, 1 mixed Pk/Pf and 1 mixed Pv/Pf. Preliminary data include a lower baseline parasite count for P. knowlesi malaria patients (median 2480/μL, IQR 538-8481) than P. falciparum (9600/μL [IQR 1446-25440]; p<0.001), and P. vivax (3882/μL, [1454-9608]; p=0.016). Parasite counts were higher in adults with P. knowlesi compared to children (median 2800 vs. 1535/μL; p=0.019). Anaemia (WHO criteria) was present in 32% (95%CI 27-36) of adults vs. 81% (95%CI 70-93) of children with knowlesi malaria (p<0.001); comparable to that seen in children with P. vivax (82%; p=0.948) or P. falciparum (76%; p=0.551). Acute kidney injury (AKIN criteria and/or creatinine >132mmol/L) was found in 26% (95% CI 22-30) of those with P. knowlesi malaria including 111/437 (25%) of adults and 13/46 (26%) of children (p=0.673). There was a higher prevalence of acute kidney injury in children with P. knowlesi malaria (26%) compared to P. vivax(12.5%; p=0.027) but not P. falciparum (30.3%; p=0.844). Severe malaria (modified WHO 2010 criteria) was present in 6.4% (95%CI 2.4-9.6%) of those with P. knowlesi overall: 32/451 (7.1%) in adults but none in children. In comparison, severe disease was seen in 6/204 (2.9%; p=0.065) with P. vivax and 4/103 (3.9%; p=0.326) with P. falciparum. There were no treatment failures in knowlesi malaria patients seen at 28 days. There was one P. knowlesi malaria death, an adult (age 62) with delayed parenteral artesunate due to misreported hyperparasitaemia. Overall P. knowlesimalaria predominantly affected adults, and while anaemia was more common in children, parasitemia was lower and severe disease was not seen.

    KW - Public, Environmental & Occupational Health Tropical Medicine

    U2 - 10.4269/ajtmh.abstract2016

    DO - 10.4269/ajtmh.abstract2016

    M3 - Meeting Abstract

    VL - 95

    SP - 205

    EP - 205

    JO - The American Journal of Tropical Medicine and Hygiene

    JF - The American Journal of Tropical Medicine and Hygiene

    SN - 0002-9637

    IS - Suppl. 5

    M1 - 651

    ER -