Indicators of fatal outcome in severe Plasmodium falciparum malaria:a study in a tertiary-care hospital in Thailand

Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.

Use of buffy coat thick films in detecting malaria parasites in patients with negative conventional thick films

Objective:To determine the frequency of malaria parasite detection from the buffy coal blood films by using capillary tube in falciparum malaria patients with negative conventional thick films.Methods:Thirty six uncomplicated falciparum malaria patients confirmed by conventional thick and thin films were included in the study.The patients were treated with artemisinin combination therapy at Hospital for Tropical Diseases,Bangkok,Thailand for 28 day.Fingerpricks for conventional blood films were conducted every 6 hours until negative parasitemia,then daily fingerpricks for parasite checks were conducted until the patients were discharged from hospital. Blood samples were also concurrently collected in 3 heparinized capillary tubes at the same time of fingerpricks for conventional blood films when the prior parasitemia was negative on thin films and parasitemia was lower than 50 parasites/200 white blood cells by thick film.The first negative conventional thick films were compared with buffy coat thick films for parasite identification. Results:Out of 36 patients with thick films showing negative for asexual forms of parasites, buffy coat films could detect remaining 10 patients(27.8%) with asexual forms of Plasmodium falciparum.Conclusions:The study shows that buffy coat thick films are useful and can detect malarial parasites in 27.8%of patients whose conventional thick films show negative parasitemia.

Definition of hyperparasitemia in severe falciparum malaria should be updated

Hyperparasitemia is one criterion of severe falciparum malariaby World Health Organization(WHO)for more than two decades[1].Although there is a correlation between density of parasittemiaand severity of malaria,some individuals with high parasite countsmay not be severely ill,whereas others with low parasitemia mayhave ultimately fatal infections.Hyperparasitemia(more than 5%