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The relationship between age and the manifestations of and mortality associated with severe malaria

Dondorp, Arjen M., Lee, S., Faiz, M., Mishra, S., Price, Ric N., Tjitra, Emiliana, Than, M., Htut, Y., Mohanty, S., Yunus, E., Rahman, R., Nosten, F., Anstey, Nicholas M., Day, Nicholas P. J. and White, Nicholas J. (2008). The relationship between age and the manifestations of and mortality associated with severe malaria. Clinical Infectious Diseases,47(2):151-157.

Document type: Journal Article

IRMA ID 75039815xPUB222
Title The relationship between age and the manifestations of and mortality associated with severe malaria
Author Dondorp, Arjen M.
Lee, S.
Faiz, M.
Mishra, S.
Price, Ric N.
Tjitra, Emiliana
Than, M.
Htut, Y.
Mohanty, S.
Yunus, E.
Rahman, R.
Nosten, F.
Anstey, Nicholas M.
Day, Nicholas P. J.
White, Nicholas J.
Journal Name Clinical Infectious Diseases
Publication Date 2008
Volume Number 47
Issue Number 2
ISSN 1058-4838   (check CDU catalogue  open catalogue search in new window)
Start Page 151
End Page 157
Total Pages 7
Place of Publication US
Publisher University of Chicago Press
Field of Research 1103 - Clinical Sciences
1108 - Medical Microbiology
0605 - Microbiology
HERDC Category C1 - Journal Article (DEST)
Abstract BACKGROUND: The reported case-fatality rate associated with severe malaria varies widely. Whether age is an independent risk factor is uncertain.

METHODS: In a large, multicenter treatment trial conducted in Asia, the presenting manifestations and outcome of severe malaria were analyzed in relation to age.

RESULTS: Among 1050 patients with severe malaria, the mortality increased stepwise, from 6.1% in children (age, <10 years) to 36.5% in patients aged >50 years (P<0.001). Compared with adults aged 21-50 years, the decreased risk of death among children (adjusted odds ratio, 0.06; 95% confidence interval, 0.01-0.23; P<0.001) and the increased risk of death among patients aged >50 years (adjusted odds ratio, 1.88; 95% confidence interval, 1.01-3.52; P<0.001) was independent of the variation in presenting manifestations. The incidence of anemia and convulsions decreased with age, whereas the incidence of hyperparasitemia, jaundice, and renal insufficiency increased with age. Coma and metabolic acidosis did not vary with age and were the strongest predictors of a fatal outcome. The number of severity signs at hospital admission also had a strong prognostic value.

CONCLUSION: Presenting syndromes in severe malaria depend on age, although the incidence and the strong prognostic significance of coma and acidosis are similar at all ages. Age is an independent risk factor for a fatal outcome of the disease.
DOI http://dx.doi.org/10.1086/589287   (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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Created: Thu, 16 Apr 2009, 15:18:14 CST by Sarena Wegener