Date Published: July 27, 2017
Publisher: Public Library of Science
Author(s): Pierre Mornand, Catherine Verret, Philippe Minodier, Albert Faye, Marc Thellier, Patrick Imbert, David Joseph Diemert.
Malaria is a leading cause of imported febrile illnesses in pediatric travelers, but few studies have addressed severe imported pediatric malaria. We aimed to determine the risk factors and the features of imported pediatric severe malaria.
We conducted a retrospective, descriptive study using the French National Reference Center for Imported Malaria database, in children aged 0–15 years who were hospitalized with a falciparum malaria from January 1st 1996 to December 31th 2005.
Of 4150 pediatric malaria cases included in the study, 3299 were uncomplicated and 851 (20.5%) were severe. Only one death was recorded during this period. Predictors for severe falciparum malaria were: age <2 years (OR = 3.2, 95% CI = 2.5–4.0, p <0.0001) and a travel in the Sahelian region (OR = 1.7, 95% CI = 1.3–2.0, p = 0.0001). Of 422 severe malaria cases, a stay in a Sahelian region, lack of chemoprophylaxis, age <2 years or thrombocytopenia <100 x 10^3/mm^3 predicted adverse outcomes. Except for the hyperparasitemia threshold of 4%, the main WHO 2000 criteria for severe malaria reliably predicted adverse outcomes. In our study, the threshold of parasitemia most predictive of a poor outcome was 8%. In imported pediatric malaria, children younger than 2 years deserve particular attention. The main WHO 2000 criteria for severity are accurate, except for the threshold of hyperparasitemia, which should be revised.
According to the World Health Organization (WHO), malaria-related mortality has declined significantly for a decade. However in 2014 malaria was responsible for about 438,000 deaths worldwide, mostly children under 5 years of age living in sub-Saharan Africa .
Very few data are available on severe pediatric imported malaria. To our knowledge, this study is the largest ever reported.
Among children with malaria after a stay in endemic zones, those at risk for severe malaria are likely to be infants, had visited a Sahelian country, missed chemoprophylaxis, or to present with thrombocytopenia <100 x 10^3/mm^3. Conversely, mixed Plasmodium species infection are protective against severe malaria. Among severe cases, a stay in Sahel, absence of chemoprophylaxis, age <2 y, presence of the major 2000 WHO criteria of severity, parasitemia 8% or a thrombocytopenia <100 x 10^3/mm^3 were relevant prognostic factors. This study provides important information to help practitioners in the evaluation and management of severe imported pediatric malaria in France. However these findings should be confirmed by prospective studies. Source: http://doi.org/10.1371/journal.pone.0180758