Plasmodium malariae infection associated with a high burden of anemia

a hospital-based surveillance study

S Langford, Nicholas (Nick) DOUGLAS, Daniel Lampah, Julie Simpson, Enny Kenangalem, Paulus Sugiarto, Nicholas Anstey, Jeanne Rini Poespoprodjo, Ric Price

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    Abstract

    Background: Plasmodium malariae is a slow-growing parasite with a wide geographic distribution. Although generally regarded as a benign cause of malaria, it has been associated with nephrotic syndrome, particularly in young children, and can persist in the host for years. Morbidity associated with P. malariae infection has received relatively little attention, and the risk of P. malariae-associated nephrotic syndrome is unknown.

    Methodology/Principal Findings:
    We used data from a very large hospital-based surveillance system incorporating information on clinical diagnoses, blood cell parameters and treatment to describe the demographic distribution, morbidity and mortality associated with P. malariae infection in southern Papua, Indonesia. Between April 2004 and December 2013 there were 1,054,674 patient presentations to Mitra Masyarakat Hospital of which 196,380 (18.6%) were associated with malaria and 5,097 were with P. malariae infection (constituting 2.6% of all malaria cases). The proportion of malaria cases attributable to P. malariae increased with age from 0.9% for patients under one year old to 3.1% for patients older than 15 years. Overall, 8.5% of patients with P. malariae infection required admission to hospital and the median length of stay for these patients was 2.5 days (Interquartile Range: 2.0–4.0 days). Patients with P. malariae infection had a lower mean hemoglobin concentration (9.0g/dL) than patients with P. falciparum (9.5g/dL), P. vivax (9.6g/dL) and mixed species infections (9.3g/dL). There were four cases of nephrotic syndrome recorded in patients with P. malariae infection, three of which were in children younger than 5 years old, giving a risk in this age group of 0.47% (95% Confidence Interval; 0.10% to 1.4%). Overall, 2.4% (n = 16) of patients hospitalized with P. malariae infection subsequently died in hospital, similar to the proportions for the other endemic Plasmodium species (range: 0% for P. ovale to 1.6% for P. falciparum).

    Conclusions/Significance: Plasmodium malariae infection is relatively uncommon in Papua, Indonesia but is associated with significant morbidity from anemia and a similar risk of mortality to patients hospitalized with P. falciparum and P. vivax infection. In our large hospital database, one in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome.
    Original languageEnglish
    Article numbere0004195
    Pages (from-to)1-16
    Number of pages16
    JournalPLoS Neglected Tropical Diseases
    Volume9
    Issue number12
    DOIs
    Publication statusPublished - 2015

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    Plasmodium malariae
    Malaria
    Anemia
    Nephrotic Syndrome
    Indonesia
    Morbidity
    Plasmodium
    Mortality
    Coinfection
    Information Systems

    Cite this

    Langford, S ; DOUGLAS, Nicholas (Nick) ; Lampah, Daniel ; Simpson, Julie ; Kenangalem, Enny ; Sugiarto, Paulus ; Anstey, Nicholas ; Poespoprodjo, Jeanne Rini ; Price, Ric. / Plasmodium malariae infection associated with a high burden of anemia : a hospital-based surveillance study. In: PLoS Neglected Tropical Diseases. 2015 ; Vol. 9, No. 12. pp. 1-16.
    @article{280a434ee881485fb1c531991cd8a40b,
    title = "Plasmodium malariae infection associated with a high burden of anemia: a hospital-based surveillance study",
    abstract = "Background: Plasmodium malariae is a slow-growing parasite with a wide geographic distribution. Although generally regarded as a benign cause of malaria, it has been associated with nephrotic syndrome, particularly in young children, and can persist in the host for years. Morbidity associated with P. malariae infection has received relatively little attention, and the risk of P. malariae-associated nephrotic syndrome is unknown.Methodology/Principal Findings: We used data from a very large hospital-based surveillance system incorporating information on clinical diagnoses, blood cell parameters and treatment to describe the demographic distribution, morbidity and mortality associated with P. malariae infection in southern Papua, Indonesia. Between April 2004 and December 2013 there were 1,054,674 patient presentations to Mitra Masyarakat Hospital of which 196,380 (18.6{\%}) were associated with malaria and 5,097 were with P. malariae infection (constituting 2.6{\%} of all malaria cases). The proportion of malaria cases attributable to P. malariae increased with age from 0.9{\%} for patients under one year old to 3.1{\%} for patients older than 15 years. Overall, 8.5{\%} of patients with P. malariae infection required admission to hospital and the median length of stay for these patients was 2.5 days (Interquartile Range: 2.0–4.0 days). Patients with P. malariae infection had a lower mean hemoglobin concentration (9.0g/dL) than patients with P. falciparum (9.5g/dL), P. vivax (9.6g/dL) and mixed species infections (9.3g/dL). There were four cases of nephrotic syndrome recorded in patients with P. malariae infection, three of which were in children younger than 5 years old, giving a risk in this age group of 0.47{\%} (95{\%} Confidence Interval; 0.10{\%} to 1.4{\%}). Overall, 2.4{\%} (n = 16) of patients hospitalized with P. malariae infection subsequently died in hospital, similar to the proportions for the other endemic Plasmodium species (range: 0{\%} for P. ovale to 1.6{\%} for P. falciparum).Conclusions/Significance: Plasmodium malariae infection is relatively uncommon in Papua, Indonesia but is associated with significant morbidity from anemia and a similar risk of mortality to patients hospitalized with P. falciparum and P. vivax infection. In our large hospital database, one in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome.",
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    author = "S Langford and DOUGLAS, {Nicholas (Nick)} and Daniel Lampah and Julie Simpson and Enny Kenangalem and Paulus Sugiarto and Nicholas Anstey and Poespoprodjo, {Jeanne Rini} and Ric Price",
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    Langford, S, DOUGLAS, NN, Lampah, D, Simpson, J, Kenangalem, E, Sugiarto, P, Anstey, N, Poespoprodjo, JR & Price, R 2015, 'Plasmodium malariae infection associated with a high burden of anemia: a hospital-based surveillance study', PLoS Neglected Tropical Diseases, vol. 9, no. 12, e0004195, pp. 1-16. https://doi.org/10.1371/journal.pntd.0004195

    Plasmodium malariae infection associated with a high burden of anemia : a hospital-based surveillance study. / Langford, S; DOUGLAS, Nicholas (Nick); Lampah, Daniel; Simpson, Julie; Kenangalem, Enny; Sugiarto, Paulus; Anstey, Nicholas; Poespoprodjo, Jeanne Rini; Price, Ric.

    In: PLoS Neglected Tropical Diseases, Vol. 9, No. 12, e0004195, 2015, p. 1-16.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Plasmodium malariae infection associated with a high burden of anemia

    T2 - a hospital-based surveillance study

    AU - Langford, S

    AU - DOUGLAS, Nicholas (Nick)

    AU - Lampah, Daniel

    AU - Simpson, Julie

    AU - Kenangalem, Enny

    AU - Sugiarto, Paulus

    AU - Anstey, Nicholas

    AU - Poespoprodjo, Jeanne Rini

    AU - Price, Ric

    PY - 2015

    Y1 - 2015

    N2 - Background: Plasmodium malariae is a slow-growing parasite with a wide geographic distribution. Although generally regarded as a benign cause of malaria, it has been associated with nephrotic syndrome, particularly in young children, and can persist in the host for years. Morbidity associated with P. malariae infection has received relatively little attention, and the risk of P. malariae-associated nephrotic syndrome is unknown.Methodology/Principal Findings: We used data from a very large hospital-based surveillance system incorporating information on clinical diagnoses, blood cell parameters and treatment to describe the demographic distribution, morbidity and mortality associated with P. malariae infection in southern Papua, Indonesia. Between April 2004 and December 2013 there were 1,054,674 patient presentations to Mitra Masyarakat Hospital of which 196,380 (18.6%) were associated with malaria and 5,097 were with P. malariae infection (constituting 2.6% of all malaria cases). The proportion of malaria cases attributable to P. malariae increased with age from 0.9% for patients under one year old to 3.1% for patients older than 15 years. Overall, 8.5% of patients with P. malariae infection required admission to hospital and the median length of stay for these patients was 2.5 days (Interquartile Range: 2.0–4.0 days). Patients with P. malariae infection had a lower mean hemoglobin concentration (9.0g/dL) than patients with P. falciparum (9.5g/dL), P. vivax (9.6g/dL) and mixed species infections (9.3g/dL). There were four cases of nephrotic syndrome recorded in patients with P. malariae infection, three of which were in children younger than 5 years old, giving a risk in this age group of 0.47% (95% Confidence Interval; 0.10% to 1.4%). Overall, 2.4% (n = 16) of patients hospitalized with P. malariae infection subsequently died in hospital, similar to the proportions for the other endemic Plasmodium species (range: 0% for P. ovale to 1.6% for P. falciparum).Conclusions/Significance: Plasmodium malariae infection is relatively uncommon in Papua, Indonesia but is associated with significant morbidity from anemia and a similar risk of mortality to patients hospitalized with P. falciparum and P. vivax infection. In our large hospital database, one in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome.

    AB - Background: Plasmodium malariae is a slow-growing parasite with a wide geographic distribution. Although generally regarded as a benign cause of malaria, it has been associated with nephrotic syndrome, particularly in young children, and can persist in the host for years. Morbidity associated with P. malariae infection has received relatively little attention, and the risk of P. malariae-associated nephrotic syndrome is unknown.Methodology/Principal Findings: We used data from a very large hospital-based surveillance system incorporating information on clinical diagnoses, blood cell parameters and treatment to describe the demographic distribution, morbidity and mortality associated with P. malariae infection in southern Papua, Indonesia. Between April 2004 and December 2013 there were 1,054,674 patient presentations to Mitra Masyarakat Hospital of which 196,380 (18.6%) were associated with malaria and 5,097 were with P. malariae infection (constituting 2.6% of all malaria cases). The proportion of malaria cases attributable to P. malariae increased with age from 0.9% for patients under one year old to 3.1% for patients older than 15 years. Overall, 8.5% of patients with P. malariae infection required admission to hospital and the median length of stay for these patients was 2.5 days (Interquartile Range: 2.0–4.0 days). Patients with P. malariae infection had a lower mean hemoglobin concentration (9.0g/dL) than patients with P. falciparum (9.5g/dL), P. vivax (9.6g/dL) and mixed species infections (9.3g/dL). There were four cases of nephrotic syndrome recorded in patients with P. malariae infection, three of which were in children younger than 5 years old, giving a risk in this age group of 0.47% (95% Confidence Interval; 0.10% to 1.4%). Overall, 2.4% (n = 16) of patients hospitalized with P. malariae infection subsequently died in hospital, similar to the proportions for the other endemic Plasmodium species (range: 0% for P. ovale to 1.6% for P. falciparum).Conclusions/Significance: Plasmodium malariae infection is relatively uncommon in Papua, Indonesia but is associated with significant morbidity from anemia and a similar risk of mortality to patients hospitalized with P. falciparum and P. vivax infection. In our large hospital database, one in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome.

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    KW - mortality

    KW - nephrotic syndrome

    KW - newborn

    KW - Plasmodium malariae infection

    KW - Plasmodium ovale malaria

    KW - Plasmodium vivax malaria

    KW - school child

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