Clinical features of severe malar ia: Protective effect of mixed plasmodial malar ia
Authors: Bagus Hermansyah, Loeki Enggar Fitri, Teguh Wahju Sardjono, Agustina Tri Endharti, Samsul Arifin, Niniek Budiarti, Didi Candradikusuma, Erma Sulistyaningsih, Nicole Berens-Riha
Number of views: 271
Objective: To investigate clinically severe malaria patients with Plasmodium falciparum
(P. falciparum), Plasmodium vivax (P. vivax) and mixed species infections.
Methods: This study was conducted at Dr. Saiful Anwar General Hospital, Malang,
Indonesia, from December 2011 to May 2013. Twenty nine patients (mean age of 41
years, 22% female), who suffered from severe malaria according to World Health Organization criteria (major and minor) and other criteria based on previous studies, were
selected by consecutive sampling. Blood samples were obtained at admission from peripheral blood for microscopic diagnostic, nested PCR and laboratory examination of
blood chemistry. Laboratory results were compared between the groups and correlated to
Results: From 29 samples, eight (28%) were diagnosed as P. falciparum mono-infection,
12 (41%) as P. vivax mono-infection and nine (31%) as mixed infections, confirmed by
PCR. Cerebral malaria occurred in P. falciparum or mixed species infection only. Parasitaemia was highest in P. falciparum mono-infection. Mean haemoglobin was signifi-
cantly lower in P. falciparum than P. vivax infection (P = 0.01). Mean thrombocyte count
(77 138/mL) was low in all groups. Mean urea, creatinine, total and direct bilirubin were
significantly higher in P. falciparum mono-infection compared to other groups, whereas
aspartate aminotransferase and alanine aminotransferase showed no significant differences. Parasitaemia was positively correlated with an increase in urea, creatinine, bilirubin
and leucocytosis in all species.
Conclusions: Both Plasmodium species can solely or in combination cause severe malaria. Mixed infection was generally more benign than P. falciparum mono-infection and
seemed to have some protective effects.