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Multidrug-Resistant Plasmodium vivax Associated with Severe and Fatal Malaria: A Prospective Study in Papua, Indonesia

Tjitra, Emiliana, Anstey, Nicholas M., Sugiarto, Paulus, Warikar, Noah, Kenangalem, Enny, Karyana, Muhammad, Lampah, Daniel A. and Price, Ric N. (2008). Multidrug-Resistant Plasmodium vivax Associated with Severe and Fatal Malaria: A Prospective Study in Papua, Indonesia. PLoS Medicine,5(6):e128.

Document type: Journal Article
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IRMA ID 10002xPUB41
Title Multidrug-Resistant Plasmodium vivax Associated with Severe and Fatal Malaria: A Prospective Study in Papua, Indonesia
Author Tjitra, Emiliana
Anstey, Nicholas M.
Sugiarto, Paulus
Warikar, Noah
Kenangalem, Enny
Karyana, Muhammad
Lampah, Daniel A.
Price, Ric N.
Journal Name PLoS Medicine
Publication Date 2008
Volume Number 5
Issue Number 6
ISSN 1549-1277   (check CDU catalogue open catalogue search in new window)
Start Page e128
Total Pages 10
Place of Publication San Francisco, CA, United States
Publisher Public Library of Science
Field of Research 1199 - Other Medical and Health Sciences
HERDC Category C1 - Journal Article (DEST)
Abstract Background
Multidrug-resistant Plasmodium vivax (Pv) is widespread in eastern Indonesia, and emerging elsewhere in Asia-Pacific and South America, but is generally regarded as a benign disease. The aim of the study was to review the spectrum of disease associated with malaria due to Pv and P. falciparum (Pf) in patients presenting to a hospital in Timika, southern Papua,
Indonesia.

Methods and Findings
Data were prospectively collected from all patients attending the outpatient and inpatient departments of the only hospital in the region using systematic data forms and hospital computerised records. Between January 2004 and December 2007, clinical malaria was present in 16% (60,226/373,450) of hospital outpatients and 32% (12,171/37,800) of inpatients. Among patients admitted with slide-confirmed malaria, 64% of patients had Pf, 24% Pv, and 10.5% mixed infections. The proportion of malarial admissions attributable to Pv rose to 47% (415/887) in children under 1 y of age. Severe disease was present in 2,634 (22%) inpatients with malaria, with the risk greater among Pv (23% [675/2,937]) infections compared to Pf (20% [1,570/7,817]; odds ratio [OR] = 1.19 [95% confidence interval (CI) 1.08–1.32], p = 0.001), and greatest in patients with mixed infections (31% [389/1,273]); overall p < 0.0001. Severe anaemia (haemoglobin < 5 g/dl) was the major complication associated with Pv, accounting for 87% (589/675) of severe disease compared to 73% (1,144/1,570) of severe manifestations with Pf (p < 0.001). Pure Pv infection was also present in 78 patients with respiratory distress and 42 patients with coma. In total 242 (2.0%) patients with malaria died during admission: 2.2% (167/7,722) with Pf, 1.6% (46/2,916) with Pv, and 2.3% (29/1260) with mixed infections (p = 0.126).

Conclusions
In this region with established high-grade chloroquine resistance to both Pv and Pf, Pv is associated with severe and fatal malaria particularly in young children. The epidemiology of P. vivax needs to be re-examined elsewhere where chloroquine resistance is increasing.
Keywords Plasmodium vivax (Pv)
eastern Indonesia
malaria
P. falciparum (Pf)
DOI http://dx.doi.org/10.1371/journal.pmed.0050128   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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