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J Infect Dis. 2015 Feb 15;211(4):623-34. doi: 10.1093/infdis/jiu487. Epub 2014 Aug 28.

Severe malarial thrombocytopenia: a risk factor for mortality in Papua, Indonesia.

Author information

1
Timika Malaria Research Program, Papuan Health and Community Development Foundation Mimika District Health Authority.
2
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University Lee Kong Chian School of Medicine, Nanyang Technological University Institute of Infectious Disease and Epidemiology, Tan Tock Seng Hospital, Singapore.
3
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne Victorian Cytology Service, Carlton, Australia.
4
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University Division of Medicine, Christchurch Hospital, New Zealand.
5
Department of Pediatrics, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
6
Rumah Sakit Mitra Masyarakat, Timika, Papua.
7
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne.
8
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University Division of Medicine, Royal Darwin Hospital, Darwin.
9
Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom.

Abstract

BACKGROUND:

The significance of thrombocytopenia to the morbidity and mortality of malaria is poorly defined. We compared the platelet counts and clinical correlates of patients with and those without malaria in southern Papua, Indonesia.

METHODS:

Data were collated on patients presenting to a referral hospital between April 2004 and December 2012.

RESULTS:

Platelet measurements were available in 215 479 patients (23.4%), 66 421 (30.8%) of whom had clinical malaria. Patients with Plasmodium falciparum monoinfection had the lowest platelet counts and greatest risk of severe thrombocytopenia (platelet count, <50,000 platelets/µL), compared with those without malaria (adjusted odds ratio [OR], 6.03; 95% confidence interval [CI], 5.77-6.30]). The corresponding risks were 5.4 (95% CI, 5.02-5.80) for mixed infections, 3.73 (95% CI, 3.51-3.97) for Plasmodium vivax infection, and 2.16 (95% CI, 1.78-2.63) for Plasmodium malariae infection (P<.001). In total, 1.3% of patients (2701 of 215 479) died. Patients with severe malarial anemia alone (hemoglobin level, <5 g/dL) had an adjusted OR for death of 4.93 (95% CI, 3.79-6.42), those with severe malarial thrombocytopenia alone had an adjusted OR of 2.77 (95% CI, 2.20-3.48), and those with both risk factors had an adjusted OR of 13.76 (95% CI, 10.22-18.54; P<.001).

CONCLUSIONS:

Severe thrombocytopenia identifies both children and adults at increased risk of death from falciparum or vivax malaria, particularly in those with concurrent severe anemia.

KEYWORDS:

Indonesia; Plasmodium falciparum; Plasmodium malariae; Plasmodium vivax; malaria; platelets; thrombocytopenia

PMID:
25170106
PMCID:
PMC4305266
DOI:
10.1093/infdis/jiu487
[Indexed for MEDLINE]
Free PMC Article

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