Clinical profiles of patients with uncomplicated Plasmodum falciparum malaria in northwestern Colombia
Keywords:
malaria, Plasmodium falciparum, chloroquine, multivariate analysis, symptoms, clinical
Abstract
Introduction. Few studies describe the clinical presentations of uncomplicated Plasmodium falciparum malaria in the province of Córdoba in an endemic area of northwestern Colombia.Objective. Profiles of patients with uncomplicated Plasmodium falciparum malaria were described from two twons of Córdoba, Tierrata and Puerto Libertador, based on clinical, epidemiological and laboratory variables.
Materials and methods. Patients were examined according to standard WHO/PAHO protocols for assessment of antimalarial drug efficacy. Clinical data and parasitological information was collected as well. A multiple correspondence multivariate analysis was used to compare the profiles of 127 patients with uncomplicated Plasmodium falciparum malaria.
Results. Of the 127patients,105 completed the 14-day follow-up and 7 had adequate clinical response. Between 80% and 98% of patients exhibited at least one of the most frequent symptoms of uncomplicated malaria, and 80.3% had asthenia as the most frequent symptom. The multivariate analysis grouped the variables into five distinguishable clusters of clinical profiles. These groups showed similarities with the classical clinical descriptions of uncomplicated malaria encountered in the literature. The low frequency of patients with adequate clinical response hampered the association analysis.
Conclusions. In Córdoba, therapeutic failure to chloroquine treatment is high in treating uncomplicated Plasmodium falciparum malaria. Multivariate analysis summarized variables related to epidemiological and clinical aspects and permitted a more objective approach to the interpretation of the findings.
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References
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3. World Health Organization. Management of severe malaria. A practical handbook. Second edition. Geneva: WHO; 2000.
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11. López YL, Arroyave A, Salazar A. Evaluación de la resistencia in vivo a medicamentos antimaláricos. El Bagre, Antioquia, 1998. Revista Epidemiológica de Antioquia. 1999;24:181-93.
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24. Osorio L, Todd J, Bradley D. Ausencia de malaria asintomática en escolares de Quibdo, Chocó. Biomédica. 2004;24:13-9.
25. González IJ, Padilla JO, Giraldo LE, Saravia NG. Eficacia de la amodiaquina y la sulfadoxina/pirimetamina en el tratamiento de la malaria no complicada por Plasmodium falciparum en Nariño, Colombia, 1999-2002. Biomédica. 2003;23:38-46.
26. Warrell DA, Turner GD, Francis N. Pathology and pathophysiology of human malaria. En: Warrell DA, Gilles HM, editores. Essential malariology. 4 ed. London: Arnold; 2002. p.236-51.
27. World Health Organization. WHO expert committee on malaria. WHO Technical Report Series 892. Twentieth Report. Geneva: WHO; 2000.
28. World Health Organization. Severe falciparum malaria. Trans R Soc Trop Med Hyg 2000; 94 (Suppl.1):S1-90.
29. Rogier C, Ly AB, Tall A, Cisse B, Trape JF. Plasmodium falciparum clinical malaria in Dielmo, a holoendemic area in Senegal: no influence of acquired immunity on initial symptomatology and severity of malaria attacks. Am J Trop Med Hyg. 1999;60:410-20.
30. Cox MJ, Kum DE, Tavul L, Narara A, Raiko A, Baisor M, et al. Dynamics of malaria parasitaemia associated with febrile illness in children from a rural area of Madang, Papua New Guinea. Trans R Soc Trop Med Hyg. 1994;88:191-7.
31. Guerra AP, Knudson A, Nicholls S, Galindo JA, Ravid Z, Rahirant S, et al. Genotipificación de los genes msp1 (bloque2) y dhfr (codón 108) de Plasmodium falciparum en muestras de campo recolectadas en cuatro localidades endémicas de Colombia. Biomédica. 2006;26:101-12.
32. Hamer DH, MacLeod WB, Addo-Yobo E, Duggan CP, Estrella B, Fawzi WW, et al. Age, temperature, and parasitaemia predict chloroquine treatment failure and anaemia in children with uncomplicated
Plasmodium falciparum malaria. Trans R Soc Trop Med Hyg. 2003;97:422-8.
33. Dorsey G, Kamya MR, Ndeezi G, Babirye JN, Phares CR, Olson JE, et al. Predictors of chloroquine treatment failure in children and adults with falciparum malaria in Kampala, Uganda. Am J Trop Med Hyg. 2000;62:686-92.
2. Mombo LE, Ntoumi F, Bisseye C, Ossari S, Lu CY, Nagel RL, et al. Human genetic polymorphisms and asymptomatic Plasmodium falciparum malaria in Gabonese schoolchildren. Am J Trop Med Hyg. 2003;68:186-90.
3. World Health Organization. Management of severe malaria. A practical handbook. Second edition. Geneva: WHO; 2000.
4. Artavanis-Tsakonas K, Tongren JE, Riley EM. The war between the malaria parasite and the immune system: immunity, immunoregulation and immunopathology. Clin Exp Immunol. 2003;133:145-52.
5. Greenwood BM. Asymptomatic malaria infections - do they matter? Parasitol Today. 1987;3:206-14.
6. Wongsrichanalai C, Pickard AL, Wernsdorfer WH, Meshnick SR. Epidemiology of drug-resistant malaria. Lancet Infect Dis. 2002;2:209-18.
7. Moore DV, Lanier JE. Observations on two Plasmodium falciparum infections with an abnormal response to chloroquine. Am J Trop Med Hyg. 1961;10:5-9.
8. Espinal CA, Cortés GT, Guerra P, Arias AE. Sensitivity of Plasmodium falciparum to antimalarial drugs in Colombia. Am J Trop Med Hyg. 1985;34:675-80.
9. Organización Panamericana de la Salud. Evaluación de la eficacia terapéutica de los medicamentos para el tratamiento de paludismo por Plasmodium falciparum sin complicaciones en las Américas. PAHO/HCP/HCT/113/98. Washington DC: Organización Panamericana de la Salud; 1998.
10. Osorio LE, Giraldo LE, Grajales LF, Arriaga AL, Andrade AL, Ruebush TK 2nd, et al. Assessment of therapeutic response of Plasmodium falciparum to chloroquine and sulfadoxine-pyrimethamine in an area of low malaria transmission in Colombia. Am J Trop Med Hyg. 1999;61:968-72.
11. López YL, Arroyave A, Salazar A. Evaluación de la resistencia in vivo a medicamentos antimaláricos. El Bagre, Antioquia, 1998. Revista Epidemiológica de Antioquia. 1999;24:181-93.
12. Blair S, Lacharme L, Carmona J, Tobón A. Resistencia del Plasmodium falciparum a los antimaláricos en Urabá y Bajo Cauca Antioqueño, 1998. Revista Epidemiológica de Antioquia. 1999;
24:207-15.
13. Castillo CM, Osorio LE, Palma GI. Assessment of therapeutic response of Plasmodium vivax and Plasmodium falciparum to chloroquine in a malaria transmission free area in Colombia. Mem Inst Oswaldo
Cruz. 2002;97:559-62.
14. Ministerio de Salud de Colombia. Guía de atención para el diagnostico y tratamiento de la malaria. Resolución No. 0412 de 2000, sección 37. [Consultado: 22 de diciembre de 2006]. Disponible en: http://www.medicosgeneralescolombianos.com/Malaria.htm
15. Echeverri M, Tobón A, Álvarez G, Carmona J, Blair S. Clinical and laboratory findings of Plasmodium vivax malaria in Colombia, 2001. Rev Inst Med Trop Sao Paulo. 2003;45:29-34.
16. González L, Guzmán M, Carmona-Fonseca J, Lopera T, Blair S. Características clínico epidemiológicas de 291 pacientes hospitalizados por malaria en Medellín (Colombia). Acta Médica Colombiana. 2000;25:163-70.
17. Instituto Nacional de Salud. Subdirección de Epidemiología y Laboratorio Nacional de Referencia - División Centros de Control de Enfermedades. SIVIGILA. Comportamiento por regiones de la malaria
en el 2001. Semana Epidemiológica No. 01. Bogotá, D.C.: Instituto Nacional de Salud; 2002.
18. Instituto Nacional de Salud. Subdirección de Epidemiología y Laboratorio Nacional de Referencia - División Centros de Control de Enfermedades. SIVIGILA. Situación de la malaria en Colombia, semana epidemiologica 44 del año 2003. Semana Epidemiológica No. 44. Bogotá, D.C.: Instituto Nacional de Salud; 2003.
19. Mendoza NM, Nicholls RS, Olano VA, Cortés LJ, Raad J. Manejo integral de la malaria. 1 ed. Bogotá D.C.: Instituto Nacional de Salud; 2000.
20. Escoffier B, Pages J. Análisis factoriales simples y múltiples. Objetivos, métodos, interpretación. Bilbao: Servicio editorial de la Universidad del País Vasco; 1990. p.49-69.
21. Lebart L, Morineau A, Piron M. Statistique exploratoire multidimensionelle. Paris: Dunod; 1995. p.108-42.
22. Trape JF, Rogier C. Combating malaria morbidity and mortality by reducing transmission. Parasitol Today. 1996;12:236-40
23. Boisier P, Jambou R, Raharimalala L, Roux J. Relationship between parasite density and fever risk in a community exposed to a low level of malaria transmission in Madagascar highlands. Am J Trop Med Hyg 2002;67:137-40.
24. Osorio L, Todd J, Bradley D. Ausencia de malaria asintomática en escolares de Quibdo, Chocó. Biomédica. 2004;24:13-9.
25. González IJ, Padilla JO, Giraldo LE, Saravia NG. Eficacia de la amodiaquina y la sulfadoxina/pirimetamina en el tratamiento de la malaria no complicada por Plasmodium falciparum en Nariño, Colombia, 1999-2002. Biomédica. 2003;23:38-46.
26. Warrell DA, Turner GD, Francis N. Pathology and pathophysiology of human malaria. En: Warrell DA, Gilles HM, editores. Essential malariology. 4 ed. London: Arnold; 2002. p.236-51.
27. World Health Organization. WHO expert committee on malaria. WHO Technical Report Series 892. Twentieth Report. Geneva: WHO; 2000.
28. World Health Organization. Severe falciparum malaria. Trans R Soc Trop Med Hyg 2000; 94 (Suppl.1):S1-90.
29. Rogier C, Ly AB, Tall A, Cisse B, Trape JF. Plasmodium falciparum clinical malaria in Dielmo, a holoendemic area in Senegal: no influence of acquired immunity on initial symptomatology and severity of malaria attacks. Am J Trop Med Hyg. 1999;60:410-20.
30. Cox MJ, Kum DE, Tavul L, Narara A, Raiko A, Baisor M, et al. Dynamics of malaria parasitaemia associated with febrile illness in children from a rural area of Madang, Papua New Guinea. Trans R Soc Trop Med Hyg. 1994;88:191-7.
31. Guerra AP, Knudson A, Nicholls S, Galindo JA, Ravid Z, Rahirant S, et al. Genotipificación de los genes msp1 (bloque2) y dhfr (codón 108) de Plasmodium falciparum en muestras de campo recolectadas en cuatro localidades endémicas de Colombia. Biomédica. 2006;26:101-12.
32. Hamer DH, MacLeod WB, Addo-Yobo E, Duggan CP, Estrella B, Fawzi WW, et al. Age, temperature, and parasitaemia predict chloroquine treatment failure and anaemia in children with uncomplicated
Plasmodium falciparum malaria. Trans R Soc Trop Med Hyg. 2003;97:422-8.
33. Dorsey G, Kamya MR, Ndeezi G, Babirye JN, Phares CR, Olson JE, et al. Predictors of chloroquine treatment failure in children and adults with falciparum malaria in Kampala, Uganda. Am J Trop Med Hyg. 2000;62:686-92.
How to Cite
1.
Knudson A, Nicholls RS, Guerra Ángela P, Sánchez R. Clinical profiles of patients with uncomplicated Plasmodum falciparum malaria in northwestern Colombia. biomedica [Internet]. 2007 Dec. 1 [cited 2024 May 18];27(4):581-93. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/175
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Published
2007-12-01
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