Imported falciparum malaria in adults: host- and parasite-related factors associated with severity. The French prospective multicenter PALUREA cohort study - Inserm - Institut national de la santé et de la recherche médicale Access content directly
Journal Articles Intensive Care Medicine Year : 2016

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

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 [Rennes] = Infectious Disease and Intensive Care [Rennes]
15 Service des maladies infectieuses et tropicales
16 Service de Maladies Infectieuses et Tropicales [CHU Pitié-Salpêtrière]
17 Services 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
Jean-Paul Mira
  • Function : Author
  • PersonId : 928244
Marie-Geneviève Huisse
  • Function : Author
  • PersonId : 1008530

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.
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Dates and versions

inserm-01524538 , version 1 (18-05-2017)

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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, 2016, 42 (10), pp.1588-96. ⟨10.1007/s00134-016-4356-x⟩. ⟨inserm-01524538⟩
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