Clinical correlates of hepatomegaly in acute childhood malaria: implications for epidemiological studies

Oral Sessions I Parasitology

158

9. Epidemiology-l

International

47 (Suppl.)

(1998)

133-281

(Malaria, etc.)

O-0177

o-017Y CORRELATES OF HEPATOMEGALY IN ACUTE CHILDHOOD MALARIA : IMPLICATIONS FOR EPIDEMIOLOGICAL STUDIES.

CLINICAL LACK OF ASSOCIATION BETWEEN LEVELS OF MATERNALLY ACQUIRED PLASMODIUM FALCIPARUM-SPECIFIC ANTIBODIES AND AGE OF ONSET OF CLINICAL MALARIA IN INFANTS IN A MALARIA ENDEMIC AREA. A&~J_E&*#* Williams

Salimonu

LS”,

Perlmann

H#o Pcrlmann

Pw* Berzins

& E. QYO-ITA’ AND M. M. MEREMIKWU2

K#.

AlO’*.

* Department

of Life Scienecs. University

of Chcmica! Department’of

Pathology, immunology.

University University

of Buea, Cameroon;

*’

College Hospital Ibadnn. of Stockholm, Sweden.

Department Nigeria;

D

A cohort of II7 newborns was followed IongitudinaIIy for 12 months to determine the age of onset of primary clinical malnria and to investigate the possible existence of a correlation between level of transpIacentally acquired Phmodirrm falciporum - specilic antibodies and age of onset of malaria in the infant. Cord blood fottd IgG and IgM were determined by the enzyme linked Immunosorbcnl aray (ELISA); antibodies to the blood stage antigen PfISS/RESA by mcmbrant immunofluore$ccnce assay: antibodies to the PflSS/RE$A E-terminal repeat sequence (EENV)4 and to the circumsporozoitc protein repeat region (NANP)6 by peptide ELISA. Haemoglobin genotype war determined by electrophoresis. The mean age of onset of malaria was 4.48f1.54 months. Twelve percent of the infants had their tint episode of malaria withn the first three months of life, 73.5% within 3-6 months and 14.3% within 6-9 months of age. Age of onsel of malaria was not influenced by sex of infant and parity of m&er. tiean (SD) age of onset of clinical malaria in haemonlobin AA infants f4.38fl.141 was significantly (P-zO.05) lower compared-with haemoglobin ‘AS (5.5Si2.43) infants. No correlation was obtained belwcen age of onset of malaria and the level of cord sertnn total IgG. IgM and antibodies to P. falciporum antigens. Cord blood seropositivity for antibodies IO the Pf155 and its C-terminal repent sequence (EENV)4 or to the (NANP)6 wotidc did not influence the ape of onset of &nical malaria. However, infants &ih haemoglobin AS whose cord blood was seropositive for antibodies to the (EENV)4 and (NANP)6 peptide showed delayed onset (P
malaria

O-0178

LIYITATIONS OP CLINICAL DIAGNOSISIN YALARIA CONTROL PROGRAM

Ohmae 11’ Leafasia J’, Bobogare A’, Farado L’, Inaba II3 -_I ‘Bureau of International Cooperation, International Medical Center of Japan, Tokyo, Japan *Solomon islands Medical Research and Training Institute, Honiara. Solomon Islands, ‘Department of Parasitology, Gunma University, Yaebashi, Japan’ We investigated the usefulness and limitations of the clinical diagnosis of malaria in primary health care (PHC) activities in malaria-endemic area of the Solomon Islands. In some clinics, validity of clinical diagnosis based on symptoms such as fever and chill, was evaluated by its sensitivity and specificity. As the progress of PHC activities. the number of severe malaria cases decreased in Honiara. capital city of Solomon Islands. In some clinics of Honlara, as slidepositive rate of malaria parasite among febrile cases decreased from 60% to 20% for recent five years, the sensitivity of clinical diagnosis was reduced, but its specificity was maintained at a high level. In a clinic of rural mountain area, the slide-positive rate among malaria suspected febrile cases was remained at 20 to 30 % for a recent few years. Based on results of the cllnical diagnosis. most of the febrile cases were treated. In these clinics, malaria suspected febrile cases were also examined by Strep ID tests to detect streptcoccal infections. Some malaria suspected febrile cases were positive for Strep ID tests, but they received antimalarial drugs such as chloroquine or quinine alone.

Departments of Community Health’ and Paediatrics2. University of Calabar Teaching Hospital, Calabar Nigeria While

splenomegaly

has

long

been

recogntzed

as

a

malanometric index in children hepatomegaly has not been used tn eptdemiologtcal sludtes of malaria Followmg recent observation by others that hepatomegal may be a more useful stgn of acute malaria in children than was previously recognized. we underlook a study of chddren with confirmed acute infectIon by Plasmodium falciDBI~~_ in Calabar, Nigeria to further describe the pattern of hepetomegaly in childhood malana Among 437 children aged 1 month 15 years wtth malaria 123 (23 2%) had hepalomegaly age groups were 32 3%

The prevalence of hepatomegaly in 30 4% 27 4%. 40 7%. 26 2% 15 2%

-

-

and 14 3% for ages ~6 months 6 llmo. 12 23mo. 24. 35m0, 36.59mo 5 9 yeam and 10 :5 years respectively The prevalence of the followmg features of severe malana: Convulstons. coma. htgh hyperpyrexia (Temp >39OC) oarasitaemia 0 SO 0001rnrn~~ and PCV c 20% were hlaher ‘among those ifth hepatomegaly vtz 21 1% 15 5% 2 4%. 73% hepatomegaly VIZ and 52 9% respectively than those without 14 % 5 7% 1 9% 5 1% and 21 7% respectively These findmgs show thal hepatomegaly with acute malarta and

may be found in only 28 3% of children may not be a sensitive non-ivasive

Index for detection of acute malaria field studies On the other hand the preponderance Jf severe features among those with hepalomegaly indicates thal It could be a valuable indicator of seventy of malana m childten

SEVERE AND COMPLICATED

O-0180

SOUTHERN MYANMAR)

A.&K’.

Men&s

‘University

ASIAN COUNTRIES

MALARIA IN TWO (SRI LANKA AND

K*. Carter R”

of Colombo.

Faculty of Medicine,

Research Unit, Kynsey Road, Colombo

Depattment

of Parasitology,

8. Sri Lanka, “University

D~vtston of Biological Sctences. Institute of Cell, Animal West Mains Road. Edinburgh EH9 3JT. b.K. Sixty three severe and compltcated from Myanmar)

Malaria

of Edinburgh,

and Population

Biology,

malaria patients (51 from Sri Lanka and I2

were studied. Twenty four patients (38%) had multiple

organ/system

dysfunction syndrome (MODS), the rest had predominant single organ pathology. Cerebral malaria (32%) formed the most important pathology in the latter group. The median age at which cerebral malaria occurred (24 years) was lower than that of MODS (32 years). The average time taken for an untreated infection to lead to a severe and complicated state was longer in MODS (7.8 days) than in cerebral malaria (4.9 days) [P=O.O16]

The mean ring parasitaemia

red blood cells) was also significantly

of MODS

malaria

(I 34

malaria

in Sri Lanka show that 80% of malaria

per 100 red blood cells)

patients (3 69 per 100

higher (P=O.O09) than in those with cerebral The data on actual treatment patients

practices for

in endemic

areas are

diagnosed and treated by the third day of symptoms. Malaria case fatality rates of southern Asia represented by these 2 countries as rangmg from 0.06 to 0.34 deaths per 1000 P.falciparum cases, are almost 2 orders of magnitude below those which prevail in most of malaria endemic tropical Africa where most deaths occur in children due to cerebral malarta contend that the rapld diagnosis and treatment Sri Lanka IS a major determtnant malarta control in Atiica.

of the age profiles

We

of the very low case fatality rates. With respect to

it is being argued whether reduction of malaria inoculation

rates, such as by use of insecticide-Impregnated malarial mortality

and anaemia.

received by the endemic patients in

bed nets would have an impact on

in the long term, and that it may achieve no more than a mere shill of severe and complicated

malaria into higher age groups. The

data presented here, however. points to the fact that, shift of incidence of severe and complicated malaria to a higher age. would result in a change ofthe clinical profile where MODS IS commoner useful in reducing compared

mortality

to cerebral

than cerebral malaria and anaemia. Such change may be as MODS

malaria,

appears significantly

and may thus provide

later during the illness

a greater opportuniry

for

intervention priorto complications. Furthermore, a shiff in age profile could itself be hfe saving because symptomatic

older children

and adults would

be better placed to

cope with a potentially lethal infection ifadequately aware oftheir given adequate opportunity to seek rapid treatment.

condition

and if