Postinjury malaria: a study of trauma victims in cambodia.
BACKGROUND
The pattern of host defense against plasmodium is comparable to the immune response to bacterial infection. Posttraumatic immunosuppression may therefore cause relapses of malaria secondary to trauma and trauma surgery in asymptomatic carriers of the parasites in endemic areas. To our knowledge this has not been validated in epidemiologic studies.


METHODS
Postinjury malaria was registered retrospectively in 342 land mine and war victims from malaria-endemic areas in Cambodia. The incidence rate was analyzed in terms of age, gender, preinjury endemicity, evacuation times, anatomic injury severity, systolic blood pressure at admission, blood transfusion, and duration of the first surgical intervention as independent variables.


RESULTS
The rate of postinjury malaria in the study patients was 33.3% (95% CI, 28.3-38.3%). Injury Severity Score (ISS) and surgical operation time were risk factors (area under the curve in receiver operating characteristic plots were 0.73 and 0.79, respectively). The impact of the other risk factors was nonsignificant.


CONCLUSIONS
Despite difficulties in diagnosing postoperative malaria in endemic areas, the study demonstrates that the rate of postinjury malaria is high. The results legitimate controlled trials of immediate postinjury chemoprophylaxis to severely injured in endemic areas. The authors recommend staged surgical operations with brief primary interventions in victims with severe injuries.
Husum
Hans
H
Tromsoe Mine Victim Resource Center, Institute of Clinical Medicine, Tromsoe University Hospital, Tromsoe, Norway. hhusum@enitel.no
Heger
Tove
T
Sundet
Mads
M
D000328:Adult; D001753:Blast Injuries / Q000469:parasitology* / Q000601:surgery; D002160:Cambodia / Q000453:epidemiology; D002648:Child; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008288:Malaria / Q000453:epidemiology* / Q000276:immunology; D008297:Male; D011183:Postoperative Complications / Q000469:parasitology*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D014857:Warfare; D014948:Wounds, Gunshot / Q000469:parasitology / Q000601:surgery; D014950:Wounds, Penetrating / Q000469:parasitology* / Q000601:surgery