Abw pitfall traps9/17/2023 ![]() ![]() ![]() While Plasmodium falciparum ( Pf) is responsible for the highest number of malarial deaths, Plasmodium vivax ( Pv) can also cause fatal disease. It is still unclear what causes these unique clinical traits in these two age and geographically distinct groups. Additionally, while CM is typically reported in combination with metabolic acidosis and/or severe anaemia in African children, it is frequently accompanied by lung, liver, and kidney dysfunction in Asian adults, resulting in ARDS, jaundice, and AKI, respectively ( Wassmer et al., 2015). In contrast, CM cases are mostly reported in older children and adults in Southeast Asia, where malaria transmission is seasonal, irregular, and do not allow the generation of a robust immunity ( Sahu et al., 2015). Children under five with CM are predominantly seen in Africa, as the malaria transmission intensity is high in sub-Saharan Africa, leading to the development of antimalarial immunity during childhood. Children under five are disproportionately affected, accounting for approximately 77% of deaths worldwide in 2020 ( WHO, 2021). Some studies showed long-term sequelae/poor outcomes in 25-50% of survivors ( WHO, 2014 Bruneel, 2019 Langfitt et al., 2019). CM is an often-fatal form of SM: it requires immediate intervention, has a mortality rate up to 30%, and long-term residual neurological complications. This results in a range of complications, organ dysfunction, and systemic inflammation, which include cerebral malaria (CM), severe anaemia, acute respiratory distress syndrome (ARDS), intestinal injury (gut leak) and acute kidney injury (AKI) ( Wassmer et al., 2015 Ouma et al., 2020 Namazzi et al., 2022 Ngai et al., 2022). SM is a broad-spectrum sepsis-like syndrome defined by organ dysfunctions caused by the excessive production of inflammatory mediators and sequestration of infected erythrocytes within the host’s microvasculature ( White et al., 2013 WHO, 2014). However, in non-exposed populations this immunity fails to build up and individuals are more likely to develop severe malaria (SM). Symptoms are often mild (e.g., fever, headaches, and vomiting) in endemic areas where populations develop a degree of immunity to the parasite, leading to uncomplicated malaria (UM) and asymptomatic malaria (AM, who harbour malarial parasites, but manifest minimal clinical symptoms) ( Mace et al., 2018 Gupta and Wassmer, 2021). Caused by apicomplexan parasites of the Plasmodium genus, the greatest burden is found in tropical and subtropical parts of the world approximately fifty percent of the world’s population is at risk of infection ( Mace et al., 2018). Malaria, a blood-borne parasitic disease, is a devastating illness that caused 247 million cases globally in 2021, increasing from the 227 million reported in 2019, and still predominantly affecting African paediatric populations ( WHO, 2022). ![]()
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