Journal Article

The Relationship between Age and the Manifestations of and Mortality Associated with Severe Malaria

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 and Nicholas J. White

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 47, issue 2, pages 151-157
Published in print July 2008 | ISSN: 1058-4838
Published online July 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/589287
The Relationship between Age and the Manifestations of and Mortality Associated with Severe Malaria

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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 150 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.

Journal Article.  3852 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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