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The prognostic value of schizontaemia in imported Plasmodium falciparum malaria

BACKGROUND: In Plasmodium falciparum infection, peripheral parasite counts do not always correlate well with the sequestered parasite burden. As erythrocytes parasitized with mature trophozoites and schizonts have a high tendency to adhere to the microvascular endothelium, they are often absent in p...

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Autores principales: van Wolfswinkel, Marlies E, de Mendonça Melo, Mariana, Vliegenthart-Jongbloed, Klaske, Koelewijn, Rob, van Hellemond, Jaap J, van Genderen, Perry J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489524/
https://www.ncbi.nlm.nih.gov/pubmed/22929647
http://dx.doi.org/10.1186/1475-2875-11-301
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author van Wolfswinkel, Marlies E
de Mendonça Melo, Mariana
Vliegenthart-Jongbloed, Klaske
Koelewijn, Rob
van Hellemond, Jaap J
van Genderen, Perry J
author_facet van Wolfswinkel, Marlies E
de Mendonça Melo, Mariana
Vliegenthart-Jongbloed, Klaske
Koelewijn, Rob
van Hellemond, Jaap J
van Genderen, Perry J
author_sort van Wolfswinkel, Marlies E
collection PubMed
description BACKGROUND: In Plasmodium falciparum infection, peripheral parasite counts do not always correlate well with the sequestered parasite burden. As erythrocytes parasitized with mature trophozoites and schizonts have a high tendency to adhere to the microvascular endothelium, they are often absent in peripheral blood samples. The appearance of schizonts in peripheral blood smears is thought to be a marker of high sequestered parasite burden and severe disease. In the present study, the value of schizontaemia as an early marker for severe disease in non-immune individuals with imported malaria was evaluated. METHODS: All patients in the Rotterdam Malaria Cohort diagnosed with P. falciparum malaria between 1 January 1999 and 1 January 2012 were included. Thick and thin blood films were examined for the presence of schizontaemia. The occurrence of WHO defined severe malaria was the primary endpoint. The diagnostic performance of schizontaemia was compared with previously evaluated biomarkers C-reactive protein and lactate. RESULTS: Schizonts were present on admission in 49 of 401 (12.2%) patients. Patients with schizontaemia were more likely to present with severe malaria, a more complicated course and had longer duration of admission in hospital. Schizontaemia had a specificity of 0.95, a sensitivity of 0.53, a negative predictive value of 0.92 and a positive predictive value of 0.67 for severe malaria. The presence of schizonts was an independent predictor for severe malaria. CONCLUSION: Absence of schizonts was found to be a specific marker for exclusion of severe malaria. Presence of schizonts on admission was associated with a high positive predictive value for severe malaria. This may be of help to identify patients who are at risk of a more severe course than would be expected when considering peripheral parasitaemia alone.
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spelling pubmed-34895242012-11-06 The prognostic value of schizontaemia in imported Plasmodium falciparum malaria van Wolfswinkel, Marlies E de Mendonça Melo, Mariana Vliegenthart-Jongbloed, Klaske Koelewijn, Rob van Hellemond, Jaap J van Genderen, Perry J Malar J Research BACKGROUND: In Plasmodium falciparum infection, peripheral parasite counts do not always correlate well with the sequestered parasite burden. As erythrocytes parasitized with mature trophozoites and schizonts have a high tendency to adhere to the microvascular endothelium, they are often absent in peripheral blood samples. The appearance of schizonts in peripheral blood smears is thought to be a marker of high sequestered parasite burden and severe disease. In the present study, the value of schizontaemia as an early marker for severe disease in non-immune individuals with imported malaria was evaluated. METHODS: All patients in the Rotterdam Malaria Cohort diagnosed with P. falciparum malaria between 1 January 1999 and 1 January 2012 were included. Thick and thin blood films were examined for the presence of schizontaemia. The occurrence of WHO defined severe malaria was the primary endpoint. The diagnostic performance of schizontaemia was compared with previously evaluated biomarkers C-reactive protein and lactate. RESULTS: Schizonts were present on admission in 49 of 401 (12.2%) patients. Patients with schizontaemia were more likely to present with severe malaria, a more complicated course and had longer duration of admission in hospital. Schizontaemia had a specificity of 0.95, a sensitivity of 0.53, a negative predictive value of 0.92 and a positive predictive value of 0.67 for severe malaria. The presence of schizonts was an independent predictor for severe malaria. CONCLUSION: Absence of schizonts was found to be a specific marker for exclusion of severe malaria. Presence of schizonts on admission was associated with a high positive predictive value for severe malaria. This may be of help to identify patients who are at risk of a more severe course than would be expected when considering peripheral parasitaemia alone. BioMed Central 2012-08-28 /pmc/articles/PMC3489524/ /pubmed/22929647 http://dx.doi.org/10.1186/1475-2875-11-301 Text en Copyright ©2012 van Wolfswinkel et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
van Wolfswinkel, Marlies E
de Mendonça Melo, Mariana
Vliegenthart-Jongbloed, Klaske
Koelewijn, Rob
van Hellemond, Jaap J
van Genderen, Perry J
The prognostic value of schizontaemia in imported Plasmodium falciparum malaria
title The prognostic value of schizontaemia in imported Plasmodium falciparum malaria
title_full The prognostic value of schizontaemia in imported Plasmodium falciparum malaria
title_fullStr The prognostic value of schizontaemia in imported Plasmodium falciparum malaria
title_full_unstemmed The prognostic value of schizontaemia in imported Plasmodium falciparum malaria
title_short The prognostic value of schizontaemia in imported Plasmodium falciparum malaria
title_sort prognostic value of schizontaemia in imported plasmodium falciparum malaria
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489524/
https://www.ncbi.nlm.nih.gov/pubmed/22929647
http://dx.doi.org/10.1186/1475-2875-11-301
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