Characteristics of Travel-Related Severe Plasmodium vivax and Plasmodium falciparum Malaria in Individuals Hospitalized at a Tertiary Referral Center in Lima, Peru

Fiorella Llanos-Chea Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas; Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

Search for other papers by Fiorella Llanos-Chea in
Current site
Google Scholar
PubMed
Close
,
Dalila Martínez Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas; Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

Search for other papers by Dalila Martínez in
Current site
Google Scholar
PubMed
Close
,
Angel Rosas Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas; Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

Search for other papers by Angel Rosas in
Current site
Google Scholar
PubMed
Close
,
Frine Samalvides Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas; Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

Search for other papers by Frine Samalvides in
Current site
Google Scholar
PubMed
Close
,
Joseph M. Vinetz Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas; Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

Search for other papers by Joseph M. Vinetz in
Current site
Google Scholar
PubMed
Close
, and
Alejandro Llanos-Cuentas Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas; Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru; Departamento de Ciencias Celulares y Moleculares, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California

Search for other papers by Alejandro Llanos-Cuentas in
Current site
Google Scholar
PubMed
Close
Restricted access

Severe Plasmodium falciparum malaria is uncommon in South America. Lima, Peru, while not endemic for malaria, is home to specialized centers for infectious diseases that admit and manage patients with severe malaria (SM), all of whom contracted infection during travel. This retrospective study describes severe travel-related malaria in individuals admitted to one tertiary care referral hospital in Lima, Peru; severity was classified based on criteria published by the World Health Organization in 2000. Data were abstracted from medical records of patients with SM admitted to Hospital Nacional Cayetano Heredia from 2006 to 2011. Of 33 SM cases with complete clinical data, the mean age was 39 years and the male/female ratio was 2.8. Most cases were contracted in known endemic regions within Peru: Amazonia (47%), the central jungle (18%), and the northern coast (12%); cases were also found in five (15%) travelers returning from Africa. Plasmodium vivax was most commonly identified (71%) among the severe infections, followed by P. falciparum (18%); mixed infections composed 11% of the group. Among the criteria of severity, jaundice was most common (58%), followed by severe thrombocytopenia (47%), hyperpyrexia (32%), and shock (15%). Plasmodium vivax mono-infection predominated as the etiology of SM in cases acquired in Peru.

Author Notes

* Address correspondence to Joseph M. Vinetz, Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, 9500 Gilman Drive, Mail Code 0760, Biomedical Research Facility 2, Room 4A16, La Jolla, CA 92093. E-mail: jvinetz@ucsd.edu

Financial support: This work was supported by U.S. Public Health Service grants U19AI089681, D43TW007120, and K24AI068903 (Joseph M. Vinetz), from the U.S. National Institutes of Health.

Authors' addresses: Fiorella Llanos-Chea and Angel Rosas, Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mails: fiorelita01@hotmail.com and angelrosasa@gmail.com. Dalila Martínez, Facultad de Medicina Alberto Hurtado, Lima, Peru, E-mail: dalila.martinez@upch.pe. Frine Samalvides and Alejandro Llanos-Cuentas, Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru, and Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mails: frine.samalvides@upch.pe and elmer.llanos@upch.pe. Joseph M. Vinetz, Center for Tropical Diseases, University of California San Diego School of Medicine, La Jolla, CA, E-mail: jvinetz@ucsd.edu.

  • 1.

    World Health Organization, 2013. World Malaria Report 2013. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/malaria/publications/world_malaria_report_2013/en/. Accessed May 31, 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Sabbag A, Schwartz E, 2010. The awareness of malaria in primary care medicine. Harefuah 149: 568–571.

  • 3.

    Siqueira AM, Lacerda MV, Magalhaes BM, Mourao MP, Melo GC, Alexandre MA, Alecrim MG, Kochar D, Kochar S, Kochar A, Nayak K, Del Portillo H, Guinovart C, Alonso P, Bassat Q, 2015. Characterization of Plasmodium vivax-associated admissions to reference hospitals in Brazil and India. BMC Med 13: 57–71.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    World Health Organization, 2014. Severe malaria. Trop Med Int Health 19 (Suppl 1): 7–131.

  • 5.

    World Health Organization, 1990. Severe and complicated malaria. World Health Organization, Division of Control of Tropical Diseases. Trans R Soc Trop Med Hyg 84 (Suppl 2): 1–65.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    World Health Organization, 2000. Severe falciparum malaria. World Health Organization, Communicable Diseases Cluster. Trans R Soc Trop Med Hyg 94 (Suppl 1): S1–S90.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    World Health Organization, 2010. Guidelines for the Treatment of Malaria, 2nd edition. Geneva, Switzerland: World Health Organization. Available at: http://www.who.int/malaria/publications/atoz/9789241547925/en/. Accessed September 28, 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Picot S, 2006. Is Plasmodium vivax still a paradigm for uncomplicated malaria? Med Mal Infect 36: 406–413.

  • 9.

    Beg MA, Khan R, Baig SM, Gulzar Z, Hussain R, Smego RA Jr, 2002. Cerebral involvement in benign tertian malaria. Am J Trop Med Hyg 67: 230–232.

  • 10.

    Koh KH, Chew PH, Kiyu A, 2005. A retrospective study of malaria infections in an intensive care unit of a general hospital in Malaysia. Singapore Med J 45: 28–36.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Kochar DK, Saxena V, Singh N, Kochar SK, Kumar SV, Das A, 2005. Plasmodium vivax malaria. Emerg Infect Dis 11: 132–134.

  • 12.

    Price RN, Douglas NM, Anstey NM, 2009. New developments in Plasmodium vivax malaria: severe disease and the rise of chloroquine resistance. Curr Opin Infect Dis 22: 430–435.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Ministerio de Salud del Peru, Direccion General de Epidemiologia, 2010. Analisis de la Situacion de Salud del Peru. Available at: http://www.dge.gob.pe/publicaciones/pub_asis/asis25.pdf. Accessed March 21, 2014.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Ministerio de Salud del Peru, 2013. Tendencia y situación de las enfermedades sujetas a vigilancia epidemiológica: malaria. Bol Epidemiol 22: 1088–1097.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Ministerio de Salud del Peru, 2007. Norma Tecnica de Salud para la Atencion de la Malaria y Malaria Grave en el Peru. Available at: http://www.minsa.gob.pe/portada/esnemo_normatividad.asp#. Accessed January 27, 2012.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Warrell DA, Cox TM, Firth JD & Benz EJ Jr (eds.), 2003. Oxford Textbook of Medicine, 4th edition. Oxford, United Kingdom: Oxford University Press.

  • 15.

    Chuquiyauri R, Paredes M, Peñataro P, Torres S, Marin S, Tenorio A, Brouwer KC, Abeles S, Llanos-Cuentas A, Gilman RH, Kosek M, Vinetz JM, 2012. Socio-demographics and the development of malaria elimination strategies in the low transmission setting. Acta Trop 121: 292–302.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Ministerio de Salud del Peru, 2001. Factores de Riesgo de la Malaria Grave en el Peru. Available at: http://bvs.minsa.gob.pe/local/minsa/1772.pdf. Accessed March 15, 2012.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Mueller I, Galinski MR, Baird JK, Carlton JM, Kochar DK, Alonso PL, del Portillo HA, 2009. Key gaps in the knowledge of Plasmodium vivax, a neglected human malaria parasite. Lancet Infect Dis 9: 555–566.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Singh H, Parakh A, Basu S, Rath B, 2011. Plasmodium vivax malaria: is it actually benign? J Infect Public Health 4: 91–95.

  • 20.

    Steenkeste N, Incardona S, Chy S, Duval L, Ekala M, Lim P, Hewitt S, Sochantha T, Socheat D, Rogier C, Mercereau-Puijalon O, Fandeur T, Ariey F, 2009. Towards high-throughput molecular detection of Plasmodium: new approaches and molecular markers. Malar J 8: 86–97.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Srivastava S, Ahmad S, Shirazi N, Kumar Verma S, Puri P, 2011. Retrospective analysis of vivax malaria patients presenting to tertiary referral centre of Uttarakhand. Acta Trop 117: 82–85.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 365 301 15
Full Text Views 339 9 0
PDF Downloads 68 6 0
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save