• 1.

    World Health Organization, 2019. World Malaria Report 2019. Geneva, Switzerland: WHO.

  • 2.

    Meara WPO, Noor A, Gatakaa H, Tsofa B, Mckenzie FE, Marsh K, 2019. The impact of primary health care on malaria morbidity - defining access by disease burden. Eur PMC Funders Gr 14: 2935.

    • Search Google Scholar
    • Export Citation
  • 3.

    Ruan Y, Guo Y, Zheng Y, Huang Z, Sun S, Kowal P, Shi Y, Wu F, 2018. Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: results from SAGE wave 1. BMC Public Health 18: 778.

    • Search Google Scholar
    • Export Citation
  • 4.

    Owolabi M, Miranda JJ, Yaria J, Ovbiagele B, 2016. Controlling cardiovascular diseases in low and middle income countries by placing proof in pragmatism. BMJ Glob Heal 1: e000105.

    • Search Google Scholar
    • Export Citation
  • 5.

    Blum JA, Zellweger MJ, Burri C, Hatz C, 2008. Cardiac involvement in African and American trypanosomiasis. Lancet Infect Dis 8: 631641.

  • 6.

    Ashley EA, Pyae Phyo A, Woodrow CJ, 2018. Malaria. Lancet 391: 16081621.

  • 7.

    World Health Organization, 2014. Severe malaria. Trop Med Int Heal 19: 7131.

  • 8.

    Craig AG, Khairul MFM, Patil PR, 2012. Cytoadherence and severe malaria. Malaysian J Med Sci 19: 518.

  • 9.

    Lee W, Russell B, Rénia L, 2019. Sticking for a cause: the falciparum malaria parasites cytoadherence paradigm. Front Immunol 10: 1444.

  • 10.

    Schofield L, Grau GE, 2005. Immunological processes in malaria pathogenesis. Nat Rev Immunol 5: 722735.

  • 11.

    Carvalho BO 2010. On the cytoadhesion of Plasmodium vivax – infected erythrocytes. J Infect Dis 202: 638647.

  • 12.

    MacPherson G, Warrell MJ, White NJ, Looareesuwan S, Warrell DA, 1985. Human cerebral malaria - a quantitative ultrastructural analysis of parasitized erythocyte sequestration. Am J Pathol 119: 385401.

    • Search Google Scholar
    • Export Citation
  • 13.

    De Alencar-Filho AC, Vinícius M, De Lacerda G, Okoshi K, Okoshi MP, 2014. Review article malaria and vascular endothelium. Arq Bras Cardiol 103: 165169.

    • Search Google Scholar
    • Export Citation
  • 14.

    Mohsen A, Green S, West JN, McKendrick M, 2001. Myocarditis associated with Plasmodium falciparum malaria: a case report and a review of the literature. J Travel Med 8: 219222.

    • Search Google Scholar
    • Export Citation
  • 15.

    Wennicke KF, Wichmann D, Brattig NW, Pankuweit S, Maisch B, Schwarz RT, Ruppert V, 2008. Glycosylphosphatidylinositol-induced cardiac myocyte death might contribute to the fatal outcome of Plasmodium falciparum malaria. Apoptosis 13: 857866.

    • Search Google Scholar
    • Export Citation
  • 16.

    Moxon CA 2014. Persistent endothelial activation and inflammation after Plasmodium falciparum infection in Malawian children. J Infect Dis 209: 610615.

    • Search Google Scholar
    • Export Citation
  • 17.

    Hotamisligil GS, 2006. Inflammation and metabolic disorders. Nature 444: 860867.

  • 18.

    Rose NR, 2011. Critical cytokine pathways to cardiac inflammation. J Interf Cytokine Res 31: 705710.

  • 19.

    World Health Organization, 2015. WHO - Guidelines for the Treatment of Malaria, 3rd edition. Geneva, Switzerland: WHO.

  • 20.

    World Health Organization, 2017. WHO Evidence Review Group Meeting, October 13–14, 2016. Geneva, Switzerland: Varemebé Conference Centre, 1314.

    • Search Google Scholar
    • Export Citation
  • 21.

    White NJ, 2007. Cardiotoxicity of antimalarial drugs. Lancet Infect Dis 7: 549558.

  • 22.

    Germany GH, Germany AK, Lenzen MJ, Denmark EP, Vranckx P, 2017. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Hear J 39: 119177.

    • Search Google Scholar
    • Export Citation
  • 23.

    Task A 2015. 2015 ESC guidelines for the diagnosis and management of pericardial diseases; the task force for the diagnosis and management of pericardial diseases of the European Society of Cardiology. Eur Hear J 36: 29212964.

    • Search Google Scholar
    • Export Citation
  • 24.

    Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB, Wu AH, Christenson RH; National Academy of Clinical Biochemistry, 2007. National academy of clinical biochemistry laboratory medicine practice guidelines: clinical characteristics and utilization of biochemical markers in. Circulation 53: 356375.

    • Search Google Scholar
    • Export Citation
  • 25.

    Lang RM 2015. Recommendations for cardiac chamber quantification by echocardiography in Adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28: 139.e14.

    • Search Google Scholar
    • Export Citation
  • 26.

    Singh V, Martinezclark P, Pascual M, Shaw ES, Neill WWO, 2010. Cardiac biomarkers – the old and the new: a review. Coron Artery Dis 21: 244256.

  • 27.

    McCullough PA, Kluger AY, 2018. Interpreting the wide range of NT-proBNP concentrations in clinical decision making. J Am Coll Cardiol 71: 1012.

    • Search Google Scholar
    • Export Citation
  • 28.

    NIH, 2020. Study Quality Assessment Tools | National Heart, Lung, and Blood Institute (NHLBI). Available at: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed October 30, 2020.

    • Search Google Scholar
    • Export Citation
  • 29.

    Nyaga VN, Arbyn M, Aerts M, 2014. Metaprop: a stata command to perform meta-analysis of binomial data. Arch Public Heal 72: 39.

  • 30.

    Egger M, Smith GD, Schneider M, Minder C, 1997. Bias in meta-analysis detected by a simple, graphical test. BMJ 315: 629634.

  • 31.

    Bhardwaj N, Ahmed Z, Sharma S, Srivastava B, Pande V, 2020. Infection, genetics and evolution clinicopathological study of potential biomarkers of Plasmodium falciparum malaria severity and complications. Infect Genet Evol 77: 104046.

    • Search Google Scholar
    • Export Citation
  • 32.

    Ray HN, Doshi D, Rajan A, Singh AK, Singh SB, Das MK, 2017. Cardiovascular involvement in severe malaria: a prospective study in. J Vector Borne Dis 54: 177182.

    • Search Google Scholar
    • Export Citation
  • 33.

    Alencar-Filho AC, Marcos Ferreira JMBB, Salinas LJ, Fabbri C, Monteiro W, Siqueira AM, Okosh K, Lacerda MVG, Okoshi MP, 2016. Cardiovascular changes in patients with non-severe Plasmodium vivax malaria. Int J Cardiol Heart Vasc 11: 1216.

    • Search Google Scholar
    • Export Citation
  • 34.

    Nayak KC, Meena SL, Gupta BK, Kumar S, Pareek V, 2013. Cardiovascular involvement in severe vivax and falciparum malaria. J Vector Borne Dis 50: 285291.

    • Search Google Scholar
    • Export Citation
  • 35.

    Stauga S, Hahn A, Brattig NW, Fischer-herr J, Baldus S, Burchard GD, Cramer JP, 2013. Clinical relevance of different biomarkers in imported Plasmodium falciparum malaria in adults: a case control study. Malar J 12: 246.

    • Search Google Scholar
    • Export Citation
  • 36.

    Herr J, Mehrfar P, Schmiedel S, Wichmann D, Brattig NW, Burchard GD, Cramer JP, 2011. Reduced cardiac output in imported Plasmodium falciparum malaria. Malar J 10: 160.

    • Search Google Scholar
    • Export Citation
  • 37.

    Mehmood A, Ejaz K, Ahmed T, 2012. Original article severity of Plasmodium vivax malaria in Karachi: a cross-sectional study. J Infect Dev Ctries 6: 664670.

    • Search Google Scholar
    • Export Citation
  • 38.

    Jain K, Chakrapani M, 2010. Acute myocardial infarction in a hospital cohort of malaria. J Glob Infect Dis 2: 7273.

  • 39.

    Ehrhardt S, Wichmann D, Hemmer CJ, Burchard GD, Brattig NW, 2004. Circulating concentrations of cardiac proteins in complicated and uncomplicated Plasmodium falciparum malaria. Trop Med Int Heal 9: 10991103.

    • Search Google Scholar
    • Export Citation
  • 40.

    Günther A, Grobusch MP, Slevogt H, Abel W, Burchard GD, 2003. Short communication: myocardial damage in falciparum malaria detectable by cardiac troponin T is rare. Trop Med Int Heal 8: 3032.

    • Search Google Scholar
    • Export Citation
  • 41.

    Mohapatra MK, Mohanty NK, Das SP, 2000. Myocardial injury: an unrecognized complication of cerebral malaria. Trop Doct 30: 188189.

  • 42.

    Franzen D, Curtius J, Heitz W, Höpp H, Diehl V, Hilger D, 1992. Clinical investigator cardiac involvement during and after malaria. Clin Investig 70: 670673.

    • Search Google Scholar
    • Export Citation
  • 43.

    Nguah SB, Hoffmann S, Herr J, Cramer JP, 2012. Cardiac function in Ghanaian children with severe malaria. Intensiv Care Med 38: 20322041.

  • 44.

    Mocumbi AO, Songane M, Salomao C, Ulibarri R, Ferreira MB, Yacoub MH, 2011. Lack of evidence of myocardial damage in children with Plasmodium falciparum severe and complicated malaria from an endemic area for endomyocardial fibrosis. J Trop Pediatr 57: 312314.

    • Search Google Scholar
    • Export Citation
  • 45.

    Murphy S, Cserti-gazdewich C, Dhabangi A, Musoke C, Nabukeera-barungi N, Paed MM, King ME, Romero J, Noviski N, Dzik W, 2011. Ultrasound findings in Plasmodium falciparum malaria: a pilot study. Pediatic Crit Care Med 12: e58e63.

    • Search Google Scholar
    • Export Citation
  • 46.

    Janka JJ 2011. Increased pulmonary pressures and myocardial wall stress in children with severe malaria. J Infect Dis 202: 791800.

  • 47.

    Ehrhardt S, Mockenhaupt FP, Anemana SD, Otchwemah RN, Wichmann D, Cramer JP, Bienzle U, Burchard GD, Brattig NW, 2005. High levels of circulating cardiac proteins indicate cardiac impairment in African children with severe Plasmodium falciparum malaria. Microbes Infect 7: 12041210.

    • Search Google Scholar
    • Export Citation
  • 48.

    Bhat S, Kumar M, Alva J, 2013. Malaria and the conducting system of the heart. BMJ Case Rep 2013: bcr2012007462.

  • 49.

    Chandra S, Chandra H, 2011. Myocardial infarction associated with Plasmodium falciparum malarial infection. Ind Med Gaz 2011: 374375.

  • 50.

    Colomba C, Trizzino M, Gioè C, Coelho F, Lopo I, Pinheiro P, Sousa J, Cascio A, 2017. Malaria and the heart: two rare case reports of Plasmodium falciparum - associated pericarditis. J Vector Borne Dis 54: 372374.

    • Search Google Scholar
    • Export Citation
  • 51.

    Costenaro P, Benedetti P, Facchin C, Mengoli C, Pellizzer G, 2011. Fatal myocarditis in course of Plasmodium falciparum infection: case report and review of cardiac complications in malaria. Case Rep Med 2011: 202083.

    • Search Google Scholar
    • Export Citation
  • 52.

    Cox-singh J 2010. Severe malaria - a case of fatal Plasmodium knowlesi infection with post-mortem findings: a case report. Malar J 9: 10.

  • 53.

    Dev N, Gadpayle AK, Sankar J, Choudhary M, 2014. Case report an unusual case of heart failure due to Plasmodium vivax infection with a favorable outcome. Rev Soc Bras Med Trop 47: 663665.

    • Search Google Scholar
    • Export Citation
  • 54.

    Gantait K, Nayak IG, 2013. Vivax malaria complicated by myocarditis. J Assoc Physicians India 61: 20122013.

  • 55.

    Genrich GL, Guarner J, Paddock CD, Shieh W, Greer PW, Barnwell JW, Zaki SR, 2007. Fatal malaria infection in travelers: novel immunohistochemical assays for the detection of Plasmodium falciparum in tissues and implications for pathogenesis. Am J Trop Med Hyg 76: 251259.

    • Search Google Scholar
    • Export Citation
  • 56.

    Gupta N, Sahoo SK, 2013. Plasmodium vivax induced myocarditis: a rare case report. Indian J Med Microbiol 31: 180182.

  • 57.

    Jain D, Nand N, Verma P, Saxena D, Jain P, 2018. Malaria causing cardiomyopathy and thrombotic microangiopathy: a rare association. Erciyes Med J 40: 237239.

    • Search Google Scholar
    • Export Citation
  • 58.

    Khan FY, 2019. Imported Plasmodium vivax malaria complicated by reversible myocarditis. J Fam Community Med 26: 232234.

  • 59.

    Khattak A, Ali W, Samore N, Idris M, Khan M, Pasha W, 2014. Complicated Plasmodium falciparum malaria initially presenting as myocarditis. J Ayub Med Coll Abbottabad 26: 413415.

    • Search Google Scholar
    • Export Citation
  • 60.

    Kim SA, Kim ES, Rhee MY, Choi SIl, Huh HJ, Chae SL, 2008. A case of myocarditis associated with Plasmodium vivax. J Travel Med 16: 138140.

  • 61.

    Kumar P, Kumar CD, Shaik FAR, Ghanta SB, 2010. Case report myocardial dysfunction in severe falciparum malaria. J Trop Pediatr 56: 6769.

  • 62.

    Maheshwari M, Resident Y, 2012. Plasmodium vivax malaria complicated by pericardial effusion. Ind Med Gaz 5: 199201.

  • 63.

    Martins AC, Lins JB, Santos LMN, Fernandes LN, Malafronte RS, Maia TC, Ribera MC, Ribera RB, da Silva-Nunes M, 2014. Vivax malaria in an Amazonian child with dilated cardiomyopathy. Malar J 13: 61.

    • Search Google Scholar
    • Export Citation
  • 64.

    Menezes RG, Kanchan T, Rai S, Rao PPJ, Naik R, Shetty BSK, Lobo SW, Chauhan A, Shetty M, Mathai AM, 2010. An autopsy case of sudden unexplained death caused by malaria. J Forensic Sci 55: 835838.

    • Search Google Scholar
    • Export Citation
  • 65.

    Miller MJ, Marcus DM, Cameron DC, 1965. Latent infections with plasmodium ovale malaria. Can Med Assoc J 92: 12411247.

  • 66.

    Nieman A, de Mast Q, Roestenberg M, Wiersma J, Pop G, Stalenhoef A, Druilhe P, Sauerwein R, van der Ven A, 2009. Cardiac complication after experimental human malaria infection: a case report. Malar J 8: 277.

    • Search Google Scholar
    • Export Citation
  • 67.

    Ruhela M, Khandelwal G, Gupta S, Bansal A, Gyanchandani N, 2019. Case report falciparum malaria mimicking acute myocardial infarction. J Fam Med Prim Care 8: 308310.

    • Search Google Scholar
    • Export Citation
  • 68.

    Sonambekar AA, Gupta N, Agarwal MP, Rajpal S, Aggarwal A, 2014. Plasmodium vivax – associated myopericarditis. Eur J Case Rep Intern Med 8: 18.

  • 69.

    Sulaiman H, Ismail MD, Jalalonmuhali M, Atiya N, 2014. Severe Plasmodium falciparum infection mimicking acute myocardial infarction. Malar J 13: 341.

    • Search Google Scholar
    • Export Citation
  • 70.

    van Meer MPA, Bastiaens GJH, Boulaksil M, de Mast Q, Gunasekera A, Hoffman SL, Pop G, van der Ven AJ, Sauerwein RW, 2014. Idiopathic acute myocarditis during treatment for controlled human malaria infection: a case report. Malar J 13: 38.

    • Search Google Scholar
    • Export Citation
  • 71.

    Ventura A, Chaves S, Monteiro JC, Sequeira CG, Ohnishi MD, Souza S, Libonati RM, Sousa RC, Souza JM, 2014. Case report myocarditis associated with Plasmodium vivax malaria: a case report. Rev Soc Bras Med Trop 47: 810813.

    • Search Google Scholar
    • Export Citation
  • 72.

    Wichmann O, Löscher T, Jelinek T, 2003. Fatal malaria in a German couple returning from Burkina Faso. Infect J 31: 20022004.

  • 73.

    Levin ESP, 1954. Vivax malaria case reports. Calif Med Case Rep 81: 8789.

  • 74.

    Jones DWC, 1919. Notes on some occasional manifestations of malaria. Lancet 194: 11311133.

  • 75.

    Trampuz A, Jereb M, Muzlovic I, Prabhu RM, 2003. Clinical review: severe malaria. Crit Care 7: 315323.

  • 76.

    Bethel DB, Tung P, Xuan C, Phuon T, Nosten F, Wallery D, 1996. Electrocardiographic monitoring in severe falciparum malaria. Trans R Soc Trop Med Hyg 90: 266269.

    • Search Google Scholar
    • Export Citation
  • 77.

    Spitz S, 1946. The pathology of acute falciparum malaria. Mil Surg 11: 555572.

  • 78.

    Lopes SCP 2014. Paucity of Plasmodium vivax mature schizonts in peripheral blood is associated with their increased cytoadhesive potential. J Infect Dis 209: 14031407.

    • Search Google Scholar
    • Export Citation
  • 79.

    Gaieski DF, Goldman JD, Holtzman DL, Shoff WH, Shepherd SM, Mehta N, Goyal M, 2013. Case report - algid malaria treated with early goal-directed therapy. Am J Emerg Med 31: 263.e5263.e10.

    • Search Google Scholar
    • Export Citation
  • 80.

    Gupta BK, Gupta A, Nehra HR, Balotia HR, Meena SL, Kumar S, 2015. Clinical profile and prognostic indicators in adults hospitalized with severe malaria caused by different Plasmodium species. Infect Dis Res Treat 8: 4550.

    • Search Google Scholar
    • Export Citation
  • 81.

    Brainin P 2019. Malaria infection and risk of incident heart failure: a nationwide cohort study. Eur Hear J 40: ehz745.0312.

  • 82.

    Hemmer CJ, Georg F, Holst E, Kern P, Chiwakata CB, 2006. Stronger host response per parasitized erythrocyte in Plasmodium vivax or ovale than in Plasmodium falciparum malaria. Trop Med Int Heal 11: 817823.

    • Search Google Scholar
    • Export Citation
  • 83.

    Val F 2017. Respiratory complications of Plasmodium vivax malaria: systematic review and meta-analysis. Am J Trop Med Hyg 97: 733743.

  • 84.

    Andrade BB, Reis-filho A, Souza-neto SM, Clarêncio J, Camargo LMA, 2010. Severe Plasmodium vivax malaria exhibits marked inflammatory imbalance. Malar J 9: 13.

    • Search Google Scholar
    • Export Citation
  • 85.

    Hojo-Souza SN 2017. On the cytokine/chemokine network during Plasmodium vivax malaria: new insights to understand the disease. Malar J 16: 42.

    • Search Google Scholar
    • Export Citation
  • 86.

    Pollack A, Kontorovich AR, Fuster V, Dec GW, 2015. Viral myocarditis—diagnosis, treatment options, and current controversies. Nat Rev Cardiol 12: 670680.

    • Search Google Scholar
    • Export Citation
  • 87.

    World Health Organization, 2013. Management of Severe Malaria: A Practical Handbook. Geneva, Switzerland: WHO.

  • 88.

    Brabin B, Dorman E, Beales P, 2000. Severe falciparum malaria. World health organization, communicable diseases cluster. Trans R Soc Trop Med Hyg 94 (Suppl 1): S1S90.

    • Search Google Scholar
    • Export Citation
  • 89.

    WHO, 1994. Severe and complicated malaria. World health organization, division of control of tropical diseases. Trans R Soc Trop Med Hyg 84 (Suppl 2): 165.

    • Search Google Scholar
    • Export Citation
  • 90.

    Roca-feltrer A, Carneiro I, Schellenberg JRMA, 2008. Estimates of the burden of malaria morbidity in Africa in children under the age of 5 years. Trop Med Int Heal 13: 771783.

    • Search Google Scholar
    • Export Citation
  • 91.

    Mascarello M, Allegranzi B, Angheben A, Anselmi M, Concia E, Laganà S, Manzoli L, Marocco S, Monteiro G, Bisoffi Z, 2008. Imported malaria in adults and children: epidemiological and clinical characteristics of 380 consecutive cases observed in Verona, Italy. J Travel Med 15: 229236.

    • Search Google Scholar
    • Export Citation
  • 92.

    Rowe JA, Claessens A, Corrigan RA, 2009. Adhesion of Plasmodium falciparum-infected erythrocytes to human cells: molecular mechanisms and therapeutic implications. Expert Rev Mol Med 11: e16.

    • Search Google Scholar
    • Export Citation
  • 93.

    Gallego-delgado J, Walther T, Rodriguez A, 2017. The high blood pressure protection - malaria. HHS Public Access 119: 10711075.

  • 94.

    Etyang AO, Smeeth L, Cruickshank JK, Scott JAG, 2016. The malaria-high blood pressure hypothesis. Circ Res 119: 3640.

  • 95.

    Etyang AO 2019. Effect of previous exposure to malaria on blood pressure in Kilifi, Kenya: a Mendelian randomization study. J Am Heart Assoc 8: e011771.

    • Search Google Scholar
    • Export Citation

 

 

 

 

Prevalence of Cardiovascular Complications in Malaria: A Systematic Review and Meta-Analysis

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  • 1 Federal University of Acre, Campus Floresta, Cruzeiro do Sul, Acre, Brazil;
  • 2 Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark;
  • 3 Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil;
  • 4 National Malaria Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark;
  • 5 Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark

ABSTRACT

Recent studies have suggested that malaria may affect the cardiovascular system. The aim of this systematic review and meta-analysis was to determine the prevalence of cardiovascular complications in symptomatic malaria patients. We searched databases such as Pubmed, Embase, Cochrane, and Web of Science (January 1950–April 2020) for studies reporting on cardiovascular complications in adults and children with malaria. Cardiovascular complications were defined as abnormalities in electrocardiogram (ECG), cardiac biomarkers, and echocardiography on admission or during outpatient examination. Studies of patients with known heart disease or cardiovascular evaluation performed after the start of intravenous antimalarial medication were excluded. The study was registered in International Prospective Register of Systematic Reviews (PROSPERO) (No.: CRD42020167672). The literature search yielded 1,243 studies, and a total of 43 studies with symptomatic malaria patients were included. Clinical studies (n = 12 adults; n = 5 children) comprised 3,117 patients, of which a majority had Plasmodium falciparum (n = 15) and were diagnosed with severe malaria (n = 13). In random-effects models of adults, the pooled prevalence estimate for any cardiovascular complication was 7% (95% CI: 5–9). No meta-analysis was conducted in children, but the range of abnormal ECG was 0–8%, cardiac biomarkers 0–57%, and echocardiography 4–9%. We analyzed 33 cases (n = 10 postmortem), in which the most common cardiovascular pathologies were myocarditis and acute coronary syndrome. All histopathological studies found evidence of parasitized red blood cells in the myocardium. Cardiovascular complications are not uncommon in symptomatic adults and children with malaria. Additional studies investigating malaria and cardiovascular disease are encouraged.

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Author Notes

Address correspondence to Philip Brainin, Federal University of Acre, Campus Floresta, Rua do Embira 341, Bairro Joao Alves, Cruzeiro do Sul, Acre 69980-000, Brazil. E-mail: denlillefilur@hotmail.com

Financial support: P. B. was funded by a research grant from the Independent Research Fund Denmark (0129-00003B).

Authors’ addresses: Anna Engell Holm, Herlev-Gentofte Hospital, Hellerup, Denmark and Federal University of Acre, Acre, Brazil, E-mail: annaengellholm@gmail.com. Laura C. Gomes, Federal University of Acre and University of São Paulo, São Paulo, Brazil, E-mail: lauracgomes@gmail.com. Claudio Romero Farias Marinho, University of São Paulo, São Paulo, Brazil, E-mail: crfmarinho@gmail.com. Odilson M. Silvestre¸Federal University of Acre, Acre, Brazil, E-mail: odilsonms@gmail.com. Lasse S. Vestergaard, Statens Serum Institut, Copenhagen, Denmark, E-mail: lav@ssi.dk. Tor Biering-Sørensen, Herlev-Gentofte Hospital, Hellerup, Denmark, and Copenhagen University, Copenhagen, Denmark, E-mail: tor.biering@gmail.com. Philip Brainin, Herlev-Gentofte Hospital, Hellerup, Denmark and Federal University of Acre, Brazil, E-mail: denlillefilur@hotmail.com.

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