Abstract
BackgroundSevere complications among patients with Plasmodium malariae infection are rare. This is the first systematic review and meta-analysis demonstrating the global prevalence and mortality of severe P. malariae infection in humans.MethodsThe systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All research articles published on the severity and mortality of P. malariae infection cases in humans were retrieved from three public databases: PubMed, Scopus, and ISI Web of Science. The pooled prevalence estimate and 95% confidence interval (CI) of complications in patients with P. malariae malaria was analysed using the random-effects model provided in Stata software. The pooled odds ratio (OR) and 95% CI of severe malaria for P. malariae infection and Plasmodium falciparum infection were analysed using Review Manager software.ResultsSix studies were used to estimate the pooled prevalence of severe P. malariae malaria. Out of 10,520 patients infected with P. malariae, the pooled prevalence estimate of severe P. malariae infection was 3% (95% CI 2–5%), with high heterogeneity (I2: 90.7%). Severe anaemia (3.32%), pulmonary complications (0.46%), and renal impairments (0.24%) were the most common severe complications found in patients with P. malariae infection. The pooled proportion of severe anaemia for P. malariae infection and P. falciparum infection was comparable among the four included studies (OR: 0.74, 95% CI 0.22–2.45, I2 = 98%). The pooled proportion of pulmonary complications was comparable between patients with P. malariae infection and those with P. falciparum infection among the four included studies (OR: 1.44; 95% CI 0.17–12.31, I2: 92%). For renal complications, the funnel plot showed that the pooled proportion of renal complications for P. malariae infection and P. falciparum infection was comparable among the four included studies (OR: 0.94, 95% CI 0.18–4.93, I2: 91%). The mortality rate of patients with P. malariae infection was 0.17% (18/10,502 cases).ConclusionsThis systematic review demonstrated that approximately two percent of patients with P. malariae infection developed severe complications, with a low mortality rate. Severe anaemia, pulmonary involvement, and renal impairment were the most common complications found in patients with P. malariae infection. Although a low prevalence and low mortality of P. malariae infection have been reported, patients with P. malariae infection need to be investigated for severe anaemia and, if present, treated aggressively to prevent anaemia-related death.
Highlights
Severe complications among patients with Plasmodium malariae infection are rare
1599 studies were screened by title and abstracts, and 1273 studies were excluded, including 677 articles not related to P. malariae, 89 book and book chapters, 24 conference papers, 39 editorials/letters/correspondence articles, 39 note articles, and 444 review articles
The pooled proportion of severe anaemia for P. malariae infection and P. falciparum infection The pooled odds ratio (OR) of severe anaemia for P. malariae infection and P. falciparum infection was comparable among the four included studies (OR: 0.74, 95% confidence interval (CI) 0.2245–2., I2 = 98%) (Fig. 4)
Summary
Severe complications among patients with Plasmodium malariae infection are rare This is the first systematic review and meta-analysis demonstrating the global prevalence and mortality of severe P. malariae infection in humans. There are five major Plasmodium species which can infect human beings, including Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae, Plasmodium ovale, and Plasmodium knowlesi [2]. Most malaria diseases in humans are caused by P. falciparum and P. vivax [4] Both species were geographically present in the southeastern and western Pacific regions, with a higher distribution of P. falciparum than P. vivax in Africa, while P. vivax is more prevalent than P. falciparum in South America [5]. P. malariae is frequently co-endemic with P. falciparum in sub-Saharan Africa, South America, Indonesia, Southeast Asia, and the western Pacific [6]. A previous study found that 7.4% of P. malariae infections were mixed infections with P. falciparum [7]
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