Prevalence and Dynamic Changes in Lung Ultrasound Findings among Adults with Uncomplicated Malaria and Controls in the Amazon Basin, Brazil

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  • 1 Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil;
  • | 2 Department of Cardiology, Gentofte Hospital, Hellerup, Denmark;
  • | 3 Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil;
  • | 4 Department of Immunology and Microbiology, Copenhagen University, Copenhagen, Denmark;
  • | 5 Department of Infectious Diseases, Rigshospitalet, Copenhagen University, Copenhagen, Denmark;
  • | 6 Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil;
  • | 7 Universidade do Estado do Amazonas, Manaus, Brazil;
  • | 8 Instituto Leônidas and Maria Deane, Fiocruz Amazonas, Manaus, Brazil;
  • | 9 National Malaria Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark;
  • | 10 Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts;
  • | 11 Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark;
  • | 12 Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil

Malaria patients are at risk of cardiopulmonary complications but diagnosis and management can be difficult in resource-limited settings. B-lines on lung ultrasound (LUS) mark changes in lung density; however, little is known about their role in malaria. We aimed to examine the prevalence of B-lines in adults with malaria at baseline and follow-up compared with controls in the Amazon Basin. We also examined the relationship between B-lines and left ventricular ejection fraction. We performed eight-zone LUS, echocardiography, and blood smears in 94 adults (mean age 40 years, 54% men) with uncomplicated malaria and 449 controls without heart failure, renal insufficiency or lung disease (mean age 41 years, 38% men). Examinations of adults with malaria were repeated after antimalarial treatment, corresponding to a median of 30 days (interquartile range [IQR] 27–39). Adults with malaria suffered from Plasmodium vivax (N = 70, median 2,823 [IQR 598–7,698] parasites/μL) or P. falciparum (N = 24, median 1,148 [IQR 480–3,128] parasites/μL). At baseline, adults with malaria more frequently had ≥ 3 B-lines (summed across eight zones) compared with controls (30% versus 2%, P value < 0.001), indicating higher lung density. When examinations were repeated, only 6% of adults with malaria had ≥ 3 B-lines at follow-up, which was significant lower compared with baseline (median reduction 3 B-line; P value < 0.001). B-lines were not significantly associated with left ventricular ejection fraction in adults with malaria. In conclusion, B-lines detected by LUS were more frequent in adults with uncomplicated malaria compared with controls and decreased after completed antimalarial treatment.

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Author Notes

Address correspondence to Alma Wegener, Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark. E-mail: almaswegener@gmail.com

Financial support: Funding specifically rewarded for the Malaria Heart Study: PB and AEH: Jette and Hans Henrik Jensen, The Independent Research Fund Denmark (0129-0003B), Dansk Medicinsk Selskab København (120620-kms), Julie von Müllens Fond, Knud Højgaards Fond (18-05-2487), A. P. Møllers Lægefond (18-L-0026), Reinholdt W. Jorck og Hustrus Fond (18-JU-0485), Eva og Henry Frænkels Mindefond (NLA-080919), Astra Zeneca/Danish Society of Cardiology, Internal Funds at Herlev-Gentofte Hospital, Torben og Alice Frimodts Fond (TA250419), Brorsons Fond (12038-1-hh), Lundbeck Foundation (R373-2021-1201). AW: Danish Heart Association (20-R139-A9644-22165), William Demant (20-1257), Knud Højgaards Fond (20-01-1076), Reinholdt W. Jorck og Hustrus Fond (20-JU-0145). MK: Novo Nordisk Fonden (NNF20OC0062782). LCG: CNPq (142306/2020-7). Other sources of funding: CRFM: FAPESP (2020/06747-4) and CNPq (302917/2019-5). No sponsors had any role in the design, conduction, or analysis of the study.

Disclosure: Dr. Platz’s employer has received support from Novartis for consulting work and she has consulted for scPharmaceuticals outside of the submitted work. She has received research support from the NIH (R01HL148439).

Authors’ addresses: Alma Wegener, Anna E. Holm, Molly Dam Kaagaard, and Philip Brainin, Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil; Department of Cardiology, Gentofte Hospital, Hellerup, Denmark, E-mails: almaswegener@gmail.com, annaengellholm@gmail.com, mollykaagaard@gmail.com, and denlillefilur@hotmail.com. Laura C. Gomes and Claudio Romero Farias Marinho, Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil, E-mails: lauracg.gomes@gmail.com and crfmarinho@gmail.com. Karine O. Lima, Luan O. Matos, Isabelle V. M. Vieira, and Rodrigo Medeiros de Souza, Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil, E-mails: kaoliveira2001@hotmail.com, matosluan2020@gmail.com, bellmnb675@gmail.com, and rodrigo.souza@ufac.br. Lars Hviid, Department of Immunology and Microbiology, Copenhagen University, Copenhagen, Denmark, and Department of Infectious Diseases, Rigshospitalet, Copenhagen University, Copenhagen, Denmark, E-mail: lhviid@sund.ku.dk. Marcus Vinícius Guimarães Lacerda, Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil, Universidade do Estado do Amazonas, Manaus, Brazil, and Instituto Leônidas and Maria Deane, Fiocruz Amazonas, Manaus, Brazil, E-mail: marcuslacerda.br@gmail.com. Lasse S. Vestergaard, National Malaria Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark, E-mail: lav@ssi.dk. Elke Platz, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, E-mail: eplatz@bwh.harvard.edu. Tor Biering-Sørensen, Department of Cardiology, Gentofte Hospital, Hellerup, Denmark, and Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark, E-mail: tor.biering@gmail.com. Odilson M. Silvestre, Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil, E-mail: odilsonms@gmail.com.

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