Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia.

Nicholas M Douglas,Gysje J Pontororing,Nicholas M Anstey,Tsin W Yeo,Enny Kenangalem,Anna P Ralph,Ric N Price,Michael J Bangs,Daniel A Lampah,Paulus Sugiarto,Jeanne Rini Poespoprodjo

doi:10.1186/s12916-014-0217-z

Abstract

BackgroundPlasmodium vivax causes almost half of all malaria cases in Asia and is recognised as a significant cause of morbidity. In recent years it has been associated with severe and fatal disease. The extent to which P. vivax contributes to death is not known.MethodsTo define the epidemiology of mortality attributable to vivax malaria in southern Papua, Indonesia, a retrospective clinical records-based audit was conducted of all deaths in patients with vivax malaria at a tertiary referral hospital.ResultsBetween January 2004 and September 2009, hospital surveillance identified 3,495 inpatients with P. vivax monoinfection and 65 (1.9%) patients who subsequently died. Charts for 54 of these 65 patients could be reviewed, 40 (74%) of whom had pure P. vivax infections on cross-checking. Using pre-defined conservative criteria, vivax malaria was the primary cause of death in 6 cases, a major contributor in 17 cases and a minor contributor in a further 13 cases. Extreme anaemia was the most common primary cause of death. Malnutrition, sepsis with respiratory and gastrointestinal manifestations, and chronic diseases were the commonest attributed causes of death for patients in the latter two categories. There were an estimated 293,763 cases of pure P. vivax infection in the community during the study period giving an overall minimum case fatality of 0.12 per 1,000 infections. The corresponding case fatality in hospitalised patients was 10.3 per 1,000 infections.ConclusionsAlthough uncommonly directly fatal, vivax malaria is an important indirect cause of death in southern Papua in patients with malnutrition, sepsis syndrome and chronic diseases, including HIV infection.

Highlights

Plasmodium vivax causes almost half of all malaria cases in Asia and is recognised as a significant cause of morbidity
Pure vivax malaria likely to have Alternative cause(s) more likely to have led to death but vivax malaria a major contributor through been a major contributor to death one of the following mechanisms: haemoglobin
Pure vivax malaria likely to have Alternative cause(s) more likely to have led to death but vivax malaria a minor contributor through been a minor contributor to death one of the following mechanisms: fever, tachycardia or anaemia

Summary

Introduction

Plasmodium vivax causes almost half of all malaria cases in Asia and is recognised as a significant cause of morbidity In recent years it has been associated with severe and fatal disease. Almost three billion people are estimated to be at risk of Plasmodium vivax malaria, the vast majority of whom live in south and southeast Asian countries [1,2]. In endemic regions, this relapsing disease is responsible for substantial morbidity, mostly associated with recurrent bouts of fever, anaemia [3] and adverse pregnancy outcomes [4,5]. In the present study we aimed to determine the extent to which P. vivax contributed to those deaths by conducting an audit of the clinical records of all patients with pure P. vivax infections who died at Mitra Masyarakat Hospital between January 2004 and September 2009

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