Please use this identifier to cite or link to this item: http://docs.prosentient.com.au/prosentientjspui/handle/1/10861
Title: Age-Related Clinical Spectrum of Plasmodium knowlesi Malaria and Predictors of Severity.
Authors: Grigg, Matthew J
William, Timothy
Barber, Bridget E
Rajahram, Giri S
Menon, Jayaram
Schimann, Emma
Piera, Kim
Wilkes, Christopher S
Patel, Kaajal
Chandna, Arjun
Drakeley, Christopher J
Yeo, Tsin W
Anstey, Nicholas M
Affiliation: Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.. Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia..
Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia.. Jesselton Medical Centre, Kota Kinabalu, Malaysia.. Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia..
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.. Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia..
Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia.. Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia.. Sabah Department of Health, Kota Kinabalu, Malaysia..
Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia.. Sabah Department of Health, Kota Kinabalu, Malaysia..
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.. Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia..
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.. Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia..
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.. Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia..
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.. Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia..
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.. Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia..
London School of Hygiene and Tropical Medicine, United Kingdom..
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.. Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia.. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.. Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore..
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia.. Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Malaysia..
Issue Date: 18-Jul-2018
Citation: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2018-07-18; 67(3): 350-359
Abstract: Plasmodium knowlesi is increasingly reported in Southeast Asia, but prospective studies of its clinical spectrum in children and comparison with autochthonous human-only Plasmodium species are lacking. Over 3.5 years, we prospectively assessed patients of any age with molecularly-confirmed Plasmodium monoinfection presenting to 3 district hospitals in Sabah, Malaysia. Of 481 knowlesi, 172 vivax, and 96 falciparum malaria cases enrolled, 44 (9%), 71 (41%), and 31 (32%) children aged ≤12 years. Median parasitemia was lower in knowlesi malaria (2480/μL [interquartile range, 538-8481/μL]) than in falciparum (9600/μL; P < .001) and vivax malaria. In P. knowlesi, World Health Organization-defined anemia was present in 82% (95% confidence interval [CI], 67%-92%) of children vs 36% (95% CI, 31%-41%) of adults. Severe knowlesi malaria occurred in 6.4% (95% CI, 3.9%-8.3%) of adults but not in children; the commenst severity criterion was acute kideny injury. No patient had coma. Age, parasitemia, schizont proportion, abdominal pain, and dyspnea were independently associated with severe knowlesi malaria, with parasitemia >15000/μL the best predictor (adjusted odds ratio, 16.1; negative predictive value, 98.5%; P < .001). Two knowlesi-related adult deaths occurred (fatality rate: 4.2/1000 adults). Age distribution and parasitemia differed markedly in knowlesi malaria compared to human-only species, with both uncomplicated and severe disease occurring at low parasitemia. Severe knowlesi malaria occurred only in adults; however, anemia was more common in children despite lower parasitemia. Parasitemia independently predicted knowlesi disease severity: Intravenous artesunate is warranted initially for those with parasitemia >15000/μL.
URI: http://docs.prosentient.com.au/prosentientjspui/handle/1/10861
DOI: 10.1093/cid/ciy065
Type: Journal Article
Appears in Collections:NT Health digital library

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