Predictive role of laboratory and clinical treatment response parameters and glucose-6-phosphate dehydrogenase status in the therapy of falciparum malaria.
Beyond the criteria of success or failure, the treatment response in malaria may be characterized by a number of clinical parameters such as fever and parasite clearance. These factors are influenced by various biochemical and haematological factors and the parasite's drug response. The aim of the study was the determination of the value of treatment response parameters and their relation to laboratory findings in the treatment of falciparum malaria, irrespective of the severity of disease and the treatment used. The study was conducted at the Hospital for Tropical Diseases in Bangkok with 119 inpatients suffering from falciparum malaria. The median fever (FCT), parasite (PCT) and symptom (SCT) clearance times were 29.75, 43.00 and 48.00 hours respectively. Fever clearance was found to be closely associated with the other two response parameters as well as with the parasite count on admission (P < 0.001), which was therefore found to be a good predictor for the expected duration of the clinical disease. Another important predictor for the persistence of fever may be the glucose-6-phosphate dehydrogenase (G6PD) status of the patients. Individuals with normal G6PD-values had almost double the FCT as compared to those with G6PD-deficiencies (46.5 versus 27.2 hrs), an indication of a protective role conferred by low G6PD-levels. A positive association between red blood cell count and FCT (P = 0.009), may be attributed to a similar protection mediated by anaemia. A possible explanation could lie in the high frequency of haemoglobinopathies in Southeast Asia and their relation to malaria. No comparable associations were noted for PCT and SCT. Particularly the fever clearance was therefore found to be a good indicator of treatment response. Several parasitological and haematological parameters, such as G6PD level and parasitaemia, were identified as reliable predictors of the expected duration of clinical disease in malaria.
Noedl
Harald
H
Department of Specific Prophylaxis and Tropical Medicine, Institute of Pathophysiology, University of Vienna, Austria. harald.noedl@univie.ac.at
Wernsdorfer
Walther H
WH
Krudsood
Srivicha
S
Wilairatana
Polrat
P
Wiedermann
Gerhard
G
Kollaritsch
Herwig
H
Looareesuwan
Sornchai
S
D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy; D005954:Glucosephosphate Dehydrogenase / Q000097:blood*; D006790:Host-Parasite Interactions; D006801:Humans; D008111:Liver Function Tests; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000188:drug therapy* / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013785:Thailand
D000962:Antimalarials; D005954:Glucosephosphate Dehydrogenase