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.
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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.",
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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 -