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Imported falciparum malaria in adults: host- and parasite-related factors associated with severity. The French prospective multicenter PALUREA cohort study

Fabrice Bruneel 1, * Florence Tubach 2, 3, 4 Jean-Paul Mira 5 Sandrine Houzé 6 Sébastien Gibot 7 Marie-Geneviève Huisse 8 Bruno Megarbane 9 Christophe Choquet 10 Philippe Corne 11 Eric Peytel 12 Daniel Villers 13 Christophe Camus 14 Olivier Bouchaud 15 Eric Caumes 16 Pierre Marie Girard 17 Fabrice Simon 18 Antoine Kalloumeh 19 Carine Roy 4, 3 Rémy Durand 20 Jacques Le Bras 6 Sophie Matheron 21 Michel Wolff 22
* Corresponding author
1 Service de réanimation [CH Versailles]
2 USPC - Université Sorbonne Paris Cité
3 CIC‑EC 1425 - Département d’Epidémiologie et Recherche Clinique [AP-HP Hôpital Bichat - Claude Bernard]
4 ECEVE (U1123 / UMR_S_1123) - Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables
5 Service de médecine d'urgence [CHU Cochin]
6 Service de Parasitologie Mycologie [AP-HP Hôpital Bichat - Claude Bernard]
7 Service de Réanimation Médicale [CHRU Nancy]
8 Service d'hématologie et immunologie
9 Service de réanimation médicale et toxicologique [AP-HP Hôpital Lariboisière]
10 Service d’Accueil des Urgences [AP-HP Hôpital Bichat - Claude Bernard]
11 Département d'anesthésie-réanimation[Montpellier]
12 Service d’Anesthésiologie et Réanimation [H.I.A Laveran, Marseille]
13 Service de Réanimation Médicale Polyvalente [Hôtel Dieu, Nantes]
14 Service des maladies infectieuses et réanimation médicale
15 Service des maladies infectieuses et tropicales
16 Service des maladies infectieuses et tropicales [CHU Pitié-Salpêtrière]
17 Service des maladies infectieuses et tropicales [CHU Saint-Antoine]
18 Service de Pathologie Infectieuse et Tropicale [HIA Laveran, Marseille]
19 Unité de Biochimie Clinique [AP-HP Hôpital Bichat-Claude-Bernard]
20 Laboratoire de Parasitologie-Mycologie [CHU Avicenne]
21 Service des maladies infectieuses et tropicales
22 Unité de Soins Intensifs et de Maladies Infectieuses
Abstract : PURPOSE: Prospective data on potential factors associated with severity of imported Plasmodium falciparum malaria are lacking. We evaluated whether several host- and parasite-related biomarkers may improve early severity evaluation. METHODS: Prospective multicenter observational study comparing uncomplicated and severe imported falciparum malaria in adults conducted in France in 52 units, from 2007 to 2010. Association of several host- and parasite-related biomarkers with severity of malaria was tested using univariate and multivariate analyses. RESULTS: Of 295 patients, 140 had uncomplicated malaria and 155 severe malaria (including very severe and less severe cases according to predefined criteria). Curative intravenous quinine treatment was used in 154/155 patients with severe malaria and atovaquone/proguanil in 74 % of patients with uncomplicated malaria. Hospital mortality was 5.2 % (8 patients), all in the severe malaria group. Among host-related biomarkers, CRP, procalcitonin, and sTREM-1 were significantly higher and albumin was significantly lower in severe versus uncomplicated malaria; only the last three biomarkers also differed significantly between the very and less severe malaria groups. Among parasite-related biomarkers, only plasma PfHRP2 was significantly higher in severe versus uncomplicated malaria and in very severe versus less severe malaria; parasitemia did not differ between very and less severe malaria. By multivariate analysis, only lower plasma albumin and higher sTREM-1 were associated with greater severity, with intermediate accuracies. CONCLUSIONS: During imported malaria, the most useful biomarkers associated with severity seem to be plasma albumin and sTREM-1; and among parasite-related parameters, PfHRP2 was more strongly associated with severity than parasitemia was.
Keywords : PCT CRP Albumin ICU PATIENTS Biomarkers STREM-1 Malaria
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INSERM | UNIV-PARIS7 | UNIV-RENNES1 | UNIV-PARIS13 | ECEVE | USPC | DCAC-UL | UNIV-RENNES | SORBONNE-UNIVERSITE | SU-MEDECINE | SORBONNE-PARIS-NORD | UNIV-PARIS | UP-SANTE | SU-TI

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Fabrice Bruneel, Florence Tubach, Jean-Paul Mira, Sandrine Houzé, Sébastien Gibot, et al.. Imported falciparum malaria in adults: host- and parasite-related factors associated with severity. The French prospective multicenter PALUREA cohort study. Intensive Care Medicine, Springer Verlag, 2016, 42 (10), pp.1588-96. ⟨10.1007/s00134-016-4356-x⟩. ⟨inserm-01524538⟩

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