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Respiratory Complications of Plasmodium vivax Malaria: Systematic Review and Meta-Analysis
Fernando Val
Fernando Val
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil;
Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil;
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Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil;
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Kim Machado
Kim Machado
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil;
Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil;
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Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil;
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Lisiane Barbosa
Lisiane Barbosa
Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil;
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Jorge Luis Salinas
Jorge Luis Salinas
Emory University School of Medicine, Atlanta, Georgia;
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André Machado Siqueira
André Machado Siqueira
Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil;
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Maria Graças Costa Alecrim
Maria Graças Costa Alecrim
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil;
Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil;
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Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil;
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Hernando del Portillo
Hernando del Portillo
Barcelona Institute for Global Health (ISGlobal) and ICREA and Institut d’Investigacioì Germans Trias i Pujol (IGTP), Badalona, Spain;
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Quique Bassat
Quique Bassat
Barcelona Institute for Global Health (ISGlobal) and ICREA, Badalona, Spain;
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Wuelton Marcelo Monteiro
Wuelton Marcelo Monteiro
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil;
Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil;
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Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil;
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Marcus Vinícius Guimarães Lacerda
Marcus Vinícius Guimarães Lacerda
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil;
Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil;
Instituto de Pesquisas Leônidas and Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil
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Malaria, a major global public health problem, is mainly caused by Plasmodium falciparum and Plasmodium vivax, and is responsible for nearly half a million deaths annually. Although P. vivax malaria was not believed to cause severe disease, recent robust studies have proved otherwise. However, the clinical spectrum and pathogenesis of severe vivax malaria and, especially, its respiratory complications remain poorly understood. A systematic search for articles reporting respiratory complications associated with vivax malaria was performed in Lilacs, Cochrane, Scielo, Web of Science, and Medline databases irrespective of publication date. Prevalence of acute respiratory distress syndrome (ARDS) and associated mortality among vivax patients were calculated from cross-sectional and longitudinal studies, whereas factors associated with mortality were calculated from data pooled from case reports and series of cases. A total of 101 studies were included (49 cross-sectional or longitudinal and 52 case reports or series of cases). Prevalence of ARDS was 2.8% and 2.2% in children and adults, respectively, with nearly 50% mortality. Moreover, female sex (P = 0.013), having any comorbidity (P = 0.036), lower body temperature (P = 0.032), lower hemoglobin (P = 0.043), and oxygen saturation (P = 0.053) values were significantly associated with mortality. Plasmodium vivax malaria respiratory complications included ARDS and were associated with high mortality. Demographics and clinical characteristics upon presentation to hospital were associated with mortality among patients with respiratory complications in vivax malaria. This study reaffirms the evidence of severe and fatal complications of P. vivax malaria and its associated respiratory complications.
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Author Notes
Authors’ addresses: Fernando Val, Kim Machado, Maria Graças Costa Alecrim, and Wuelton Marcelo Monteiro, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil, and Universidade do Estado do Amazonas, Manaus, Brazil, E-mails: ffaval@gmail.com, kim.machado01@gmail.com, galecrim@fmt.am.gov.br, and wueltonmm@gmail.com. Lisiane Barbosa, Universidade do Estado do Amazonas, Manaus, Brazil, E-mail: lisianerisia@gmail.com. Jorge Luis Salinas, Emory University School of Medicine, Atlanta, GA, E-mail: jlsalinas@emory.edu. André Machado Siqueira, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil, E-mail: amsiqueira@gmail.com. Hernando del Portillo, Barcelona Institute for Global Health (ISGlobal) and ICREA and Institut d’Investigacioì Germans Trias i Pujol (IGTP), Badalona, Spain, E-mail: hernandoa.delportillo@isglobal.org. Quique Bassat, Barcelona Institute for Global Health (ISGlobal) and ICREA, Badalona, Spain, E-mail: quique.bassat@isglobal.org. Marcus Vinícius Guimarães Lacerda, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil, Universidade do Estado do Amazonas, Manaus, Brazil, and Instituto de Pesquisas Leônidas and Maria Deane, Fundação Oswaldo Cruz, Rua Terezina, Manaus, Brazil, E-mail: marcuslacerda.br@gmail.com.
Financial support: This work was funded by the National Counsel of Technological and Scientific Development [Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)], the Amazonas Research Foundation [Fundação de Amparo à Pesquisa do Estado do Amazonas (FAPEAM)], and The Fogarty International Center Global Health Fellowship [R25TW009337].
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