Inter-relationships of cardinal features and outcomes of symptomatic pediatric Plasmodium falciparum MALARIA in 1,933 children in Kampala, Uganda.
Malaria remains a challenging diagnosis with variable clinical presentation and a wide spectrum of disease severity. Using a structured case report form, we prospectively assessed 1,933 children at Mulago Hospital in Kampala, Uganda with acute Plasmodium falciparum malaria. Children with uncomplicated malaria significantly differed from those with severe disease for 17 features. Among 855 children with severe disease, the case-fatality rate increased as the number of severity features increased. Logistic regression identified five factors independently associated with death: cerebral malaria, hypoxia, severe thrombocytopenia, leukocytosis, and lactic acidosis. Cluster analysis identified two groups: one combining anemia, splenomegaly, and leukocytosis; and a second group centered on death, severe thrombocytopenia, and lactic acidosis, which included cerebral malaria, hypoxia, hypoglycemia, and hyper-parasitemia. Our report updates previous clinical descriptions of severe malaria, quantifies significant clinical and laboratory inter-relationships, and will assist clinicians treating malaria and those planning or assessing future research (NCT00707200) (www.clinicaltrials.gov).
Christine M
CM
Cserti-Gazdewich
Aggrey
A
Dhabangi
Charles
C
Musoke
Isaac
I
Ssewanyana
Henry
H
Ddungu
Deborah
D
Nakiboneka-Ssenabulya
Nicolette
N
Nabukeera-Barungi
Arthur
A
Mpimbaza
Walter H
WH
Dzik
D000140:Acidosis, Lactic / Q000469:parasitology / Q000473:pathology; D000740:Anemia / Q000469:parasitology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D006801:Humans; D007003:Hypoglycemia / Q000469:parasitology / Q000473:pathology; D000860:Hypoxia / Q000469:parasitology / Q000473:pathology; D007223:Infant; D007964:Leukocytosis / Q000469:parasitology / Q000473:pathology; D016015:Logistic Models; D016779:Malaria, Cerebral / Q000401:mortality; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D018512:Parasitemia / Q000469:parasitology / Q000473:pathology; D010963:Plasmodium falciparum / Q000472:pathogenicity*; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013163:Splenomegaly / Q000469:parasitology / Q000473:pathology; D013921:Thrombocytopenia / Q000469:parasitology / Q000473:pathology; D014454:Uganda / Q000453:epidemiology