Publication: The relationship between age and the manifestations of and mortality associated with severe malaria
Issued Date
2008-07-15
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ISSN
10584838
DOI
Other identifier(s)
2-s2.0-46349095576
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Mahidol University
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SCOPUS
Bibliographic Citation
Clinical Infectious Diseases. Vol.47, No.2 (2008), 151-157
Suggested Citation
Arjen M. Dondorp, Sue J. Lee, M. A. Faiz, Saroj Mishra, Ric Price, Emiliana Tjitra, Marlar Than, Ye Htut, Sanjib Mohanty, Emran Bin Yunus, Ridwanur Rahman, Francois Nosten, Nicholas M. Anstey, Nicholas P.J. Day, Nicholas J. White The relationship between age and the manifestations of and mortality associated with severe malaria. Clinical Infectious Diseases. Vol.47, No.2 (2008), 151-157. doi:10.1086/589287 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/19600
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Title
The relationship between age and the manifestations of and mortality associated with severe malaria
Other Contributor(s)
Mahidol University
Shoklo Malaria Research Unit
University of Oxford
Dhaka Medical College
Chittagong Medical College
Ispat General Hospital
Menzies School of Health Research
Badan Penelitian Dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia
Defence Services General Hospital
Department of Medical Research
Shoklo Malaria Research Unit
University of Oxford
Dhaka Medical College
Chittagong Medical College
Ispat General Hospital
Menzies School of Health Research
Badan Penelitian Dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia
Defence Services General Hospital
Department of Medical Research
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 < .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 < .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 = .046) 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. © 2008 by the Infectious Diseases Society of America. All rights reserved.