13. Malaria is a vector-borne disease that affected over 200 million
people in 2019. And imposes a significant economic burden on
endemic countries. According to the 2019 WHO malaria report,
19 countries collectively account for 85% of global malaria
burden (WHO, 2019).
All of these high-burden countries are also resource poor, and
(except for India) are located in sub-Saharan Africa (SSA). In
these countries, Plasmodium falciparum and P. vivax infections
account for the majority of malaria cases (WHO, 2019).
14. In Egypt, malaria has been endemic in all governorates, Recent
data strongly suggested that malaria is re-emerging in the
country where 24 locally contracted cases were reported in
Aswan governorate in 2014 (El-kady et al., 2017).
Also, available epidemiological evidence suggests that in areas
where malaria was eliminated, but the vectors still exist, there
is a risk of re-emergence of the disease (Dahesh and Mustafa,
2015).
15. This particular situation applies to Fayoum governorate as it
was the last focus of malaria, and the main mosquito vectors
are still prevalent (Saleh et al., 2016), therefore a potential for
resurgence exists.
16.
17. Interrupt malaria transmission and reduce mortality in
endemic areas.
Decrease the economic burden of malaria by the proper
treatment.
18. To estimate the prevalence of malaria infection among
cases admitted to military fever hospital.
To describe the epidemiological and clinical
characteristics of the patients Admitted to the Fever
Hospital who proved infected with malaria.
To differentiate between severe and uncomplicated cases
of malaria by Clinical presentation, platelet count and
blood film.
19. To study the incidence of thrombocytopenia in patients
admitted to the military Fever Hospital who proved
infected with malaria.
To study the outcome and the efficacy of treatment of
patients admitted to the Military Fever Hospital who
proved infected with malaria.
20.
21. Design and Settings:
• This is a Retrospective cohort study including all patients
suffering of malaria attending a Military Fever Hospital.
• Data was collected from January 2018 to September 2022.
22. In order to evaluate the state of malaria as a cause of fever, 112
patients were selected from those admitted to Military Fever Hospital.
Inclusion criteria:
• Clinical manifestations (Despommier DD, et al., 2019).
• Positive Rapid Malaria Test.
• Positive Blood Film for malaria.
Study population:
Exclusion criteria:
• Negative Rapid Malaria Test.
• Negative blood film of malaria in patients suspected to have Malaria.
24. Full history.
Thorough examination:
Fever analysis as a main complain.
Frequency of clinical symptoms and signs.
Severe malarial manifestations.
Laboratory Investigations (CBC, liver function and kidney
function).
Serological tests.
Ultrasonography; A real time scanning device.
Tool of the study:
25. Methods
a) A full detailed clinical assessment and history in the form of
questionnaire was designed for each individual to determine
the risk factors with specific emphasis to age, sex, residence,
occupation and travel history to a country.
b) Serum samples for Rapid diagnostic test:
Malaria P.F/Pan Rapid Test Device (Whole Blood).
Thin blood films.
Thick blood films.
C) Therapy and Follow up.
d) Clinical outcome of the studied cases.
26.
27. Socio- demographic Data
No %
Age (years) Mean± SD 27.0±7.5
Range 20-60
Age groups 20-25 65 58.0
26-30 24 21.5
31-35 10 8.9
36-40 5 4.5
≥41 8 7.1
Gender Males 110 98.2
Female 2 1.8
Occupation Military 102 91.1
None Military 10 8.9
Residence Country Egypt 109 97.3
Outside Egypt 3 2.7
Residence Local Region Great Cairo 40 36.7
Delta region 22 20.2
Alex region 19 17.4
Upper Egypt 17 15.6
Canal Region 11 10.1
28. Geographical distribution for imported cases
and travel history
No %
Travel Country Central Africa 57 50.9
Mali 21 18.8
Sudan 20 17.9
Congo 7 6.3
South Sudan 4 3.6
Tanzania 2 1.8
South Africa 1 0.9
Travel Duration(months) Mean± SD 8.5±4.3
Range 0.15-23.2
Travel Duration ≤ 6 months 48 42.9
> 6 months 64 57.1
Previous Infection No 57 50.9
Yes 55 49.1
No of Infections (n=55) Once 24 43.6
More than one time 31 56.4
Median (Range) 2(1-10)
30. Clinical presentation and prevention strategies
0 20 40 60 80 100
Fever
Vomiting
Disturbed Conscious Level
Jaundice
Symptoms
and
signs
100
47.3
23.2
18.8
Percentage
Bar chart representing symptoms and signs among studied patients
31. Clinical presentation and prevention strategies
laboratory investigations Normal level Mean SD Median Minimum Maximum
Total Bilirubin(mg/dL) 0.1 to 1.2 1.8 1.9 1.2 0.3 12.0
Direct Bilirubin(mg/dL) 0.0 to 0.3 0.9 1.2 0.5 0.1 8.2
Albumin(g/dL) 3.4 to 5.4 3.8 0.7 3.9 1.7 5.6
ALT(u/L) 7 to 55 40.5 28.9 31 11 208
AST(u/L) 8 to 48 42.1 28.2 34 12 176
Creatinine(mg/dL) 0.7 to 1.3 1.1 0.3 1.1 0.6 2.4
Urea(mg/dL) 6 to 24 40.4 15.7 38.5 12 105
HB(g/dl) 12 to 16 12.0 1.9 12 6.3 16.2
RBCs(/L) 4.0 to 5.9 x
10*12
4.4 0.9 4.5 2.1 6.4
WBC(ML) 4,500 to
11,000
6.3 1.8 6.3 2.2 11.9
Platelet count /Day 0(ML) 150,000 to
450,000
88.5 51.5 81.5 11 306
Platelet count /Day 3(ML) 150,000 to
450,000
121.2 55.5 110 20 298
Platelet count /Day 7(ML) 150,000 to
450,000
213.6 68.5 202 20 440
Descriptive statistics of laboratory investigations
32. Clinical presentation and prevention strategies
Bar chart representing Prevention strategies among studied patients
0
10
20
30
40
50
60
70
80
90
100
Health Education Chemoprophylaxis
(Doxy)
Mosquito Control
100
83.9 83
Percentage
33. Treatment, severity of cases and related outcome
No %
Severity Sever (Cerebral) 27 24.1
Severe (Non Cerebral) 35 31.3
Uncomplicated 50 44.6
Treatment Artimethenine Derivatives oral 50 44.6
Artimethenine Derivatives IV 35 31.3
Quinine IV 27 24.1
Treatment Duration(days) Mean± SD 9.3±2.8
Range 3-17
Complications Uncomplicated 50 44.6
Complicated 62 55.4
Outcome Cured 110 98.2
Died 2 1.8
ICU Admission No 85 75.9
Yes 27 24.1
34. Comparison between complicated & non-complicated malaria
Uncomplicated
(n=50)
Complicated
(n=62)
n (%) n (%) P value
Age(years) Mean ±SD 25.6±5.4 28.1±8.7 0.063
Range 20-46 21-60
Gender Male 50(45.5) 60(54.5) 0.501
Female 0 2(100.0)
Age group 20-25 32(49.2) 33(50.8) 0.088
26-30 13(54.2) 11(45.8)
31-35 2(20.0) 8(80.0)
36-40 0 5(100.0)
≥41 3(37.5) 5(62.5)
Occupation None Military 2(20.0) 8(80.0) 0.100
Military 48(47.1) 54(52.9)
35. Comparison between complicated & non-complicated malaria
Uncomplicated
(n=50)
Complicated
(n=62)
n (%) n (%) P value
Residence country Egypt 50(45.9) 59(54.1) 0.252
Outside Egypt 0 3(100.0)
Residence Region Great Cairo 13(32.5) 27(67.5) 0.105
Alex region 13(68.4) 6(31.6)
Delta region 11(50.0) 11(50.0)
Upper Egypt 9(52.9) 8(47.1)
Canal Region 4(36.4) 7(63.6)
36. Uncomplicated
(n=50)
Complicated
(n=62)
n (%) n (%) P value
Travel Country Central Africa 26(45.6) 31(54.4) NA
Mali 12(57.1) 9(42.9)
Sudan 9(45.0) 11(55.0)
Congo 2(28.6) 5(71.4)
South Sudan 0 4(100.0)
South Africa 0 1(100.0)
Tanzania 1(50.0) 1(50.0)
Travel duration ≤ 6 months 22(45.8) 26(54.2) 0.826
> 6 months 28(43.8) 36(56.3)
Previous Infection No 29(50.9) 28(49.1) 0.177
Yes 21(38.2) 34(61.8)
No. of infections Once 12(50.0) 12(50.0) 0.112
More than one time 9(29.0) 22(71.0)
37. Uncomplicated
(n=50)
Complicated
(n=62)
n (%) n (%) P value
Chemoprophylaxis(Doxycycline) No 3(16.7) 15(83.3) 0.009
Yes 47(50.0) 47(50.0)
Mosquito control No 6(31.6) 13(68.4) 0.209
Yes 44(47.3) 49(52.7)
DCL No 50(58.1) 36(41.9) <0.001
Yes 0 26(100.0)
Vomiting No 48(81.4) 11(18.6) <0.001
Yes 2(3.8) 51(96.2)
Jaundice No 50(54.9) 41(45.1) <0.001
Yes 0 21(100.0)
PA US Free 24(96.0) 1(4.0) <0.001
HSM 26(29.9) 61(70.1)
Treatment Artimethenine
Derivatives IV
0 35(100.0) <0.001
Artimethenine
Derivatives oral
50(100.0) 0
Quinine IV 0 27(100.0)
39. Uncomplicated(n=50) Complicated(n=62)
Mean ±SD Mean ±SD P value
Total Bilirubin*(mg/dl) 1.1(0.3-1.8) 1.6(0.4-12.0) <0.001
Direct Bilirubin*(mg/dl) 0.5(0.1-1.0) 0.7(0.1-8.2) <0.001
ALT*(mg/dl) 23.5(11.0-94.0) 41.0(13.0-20.8) <0.001
AST*(mg/dl) 30.0(12.0-67.0) 44.0(12.0-176.0) <0.001
ALB (g/dl) 3.92±0.73 3.68±0.74 0.099
Cr (mg/dl) 1.12±0.23 1.16±0.37 0.557
Urea (mg/dl) 36.82±11 43.21±18.19 0.031
HB (g/dl) 12.75±1.45 11.45±2.1 <0.001
RBCs (/L) 4.65±0.6 4.27±1 0.020
WBC (M/L) 6.3±1.78 6.32±1.88 0.967
Platelet count Day 0 /
(M/L)
121.6±52.41 61.87±31.69 <0.001
Platelet count Day 3 /
(M/L)
157.86±47.97 91.71±42.14 <0.001
Platelet count Day 7 /
microliter
252±54.87 183.26±62.94 <0.001
40. Predictors of the occurrence of complications
95% CI for OR
B S.E. P value OR Lower Upper
Platelet count Day0 -0.041 0.014 0.003 0.959 0.934 0.986
Platelet count Day7 -0.020 0.005 <0.001 0.981 0.971 0.991
PA US 3.032 1.132 0.007 20.74 2.25 190.6
Constant 8.565 1.867 0 5244.0
41.
42. Age of majority of cases was (20-25) years (58%), majority were
males, military staff, Egyptian and from great Cairo.
Nearly half of them reported history of previous infection with median
two times infection episodes and range (1-10) times. The number of
imported cases was the least in 2018 only 2 patients and increased
dramatically in 2019 then declined after that in 2020 & 2021.
Conclusions
43. (44.6%) were uncomplicated while (35, 31.3%) had severe non
cerebral presentation. Majority of patients (85, 75.9%) received
Artimethenine Derivatives either oral (50, 44.6%) or intravenous (35,
31.3%). (55.4%) patients were complicated, (24.1%) needed ICU
admission and only two patients died.
In complicated patients; 26 patients (100%) had DCL compared to
36(41.9%) with no DCL. Complicated cases also had higher rates of
vomiting (51, 96% vs 11, 18.6%), jaundice (21,100.0% vs 41, 45.1%).
Complicated cases had longer duration of treatment compared to non-
complicated cases.
Conclusions
44. Complicated cases had higher levels of total bilirubin, direct bilirubin,
ALT, AST and Urea compared to non-complicated cases, p<0.001. While
had lower levels of Platelet, Hb and RBCs compared to non-complicated
cases, p<0.001.
Platelets count at day 0 and platelets count showed an inverse
association with complications risk, the higher the platelet count the
lesser the risk to be complicated, OR=0.959(0.934-0.986) for platelets
count at day 0 (decrease risk by 5% with each unit increase in Platelet
count).
Conclusions
45.
46. From the results of this study, certain recommendations to the public and
to health professionals are suggested:
Keeping malaria in the differential diagnosis of all acute fevers is
necessary.
Malaria should always be suspected in any febrile patient who has
traveled to an endemic area. There could even be other less common
routes of infection, requiring prompt diagnosis and treatment.
Recommendations
47. Chemoprophylaxis which tends to be ignored and neglected by some
health professionals needs not be emphasized, and from the results of
this study it was clear that many patients have traveled to endemic
areas.
There should be adequate health education for patients living in and
travelling to endemic areas. In addition, there should be awareness of
the possibility of complications in patients who fail to improve clinically.
Alternative drugs may be used in such cases.
Recommendations
48. These observations provide an impetus to study the different issues
related to severe malaria including underlying pathogenesis of severe
disease.
Our study may also prove to be an initiator for further research into
possible genotypic abnormalities that the parasite or its carrier may
have acquired over decades of aggression of insecticides, injudicious
usage of conventional antimalarials, ecological transformations due to
industrialization and possible co-infection with certain viruses.
Recommendations
