Concurrent Helminthic Infection Protects Schoolchildren with Plasmodium vivax from Anemia

malaria in rural areas in the municipality of Careiro, in the Western Brazilian Amazon. (n = 9). In children without intestinal helminthes, a significant decrease in the hemoglobin during the malarial attack was seen as compared to the baseline concentration. In the survival analysis, no difference was seen in the time (in days) from the baseline cross-sectional to the first malarial infection, between parasitized and non-parasitized children.

Risk Factors and Characterization of Plasmodium Vivax-Associated Admissions to Pediatric Intensive Care Units in the Brazilian Amazon

BACKGROUND: Plasmodium vivax is responsible for a significant proportion of malaria cases worldwide and is increasingly reported as a cause of severe disease. The objective of this study was to characterize severe vivax disease among children hospitalized in intensive care units (ICUs) in the Western Brazilian Amazon, and to identify risk factors associated with disease severity. METHODS AND FINDINGS: In this retrospective study, clinical records of 34 children, 0-14 years of age hospitalized in the 11 public pediatric and neonatal ICUs of the Manaus area, were reviewed. P. falciparum monoinfection or P. falciparum/P. vivax mixed infection was diagnosed by microscopy in 10 cases, while P. vivax monoinfection was confirmed in the remaining 24 cases. Two of the 24 patients with P. vivax monoinfection died. Respiratory distress, shock and severe anemia were the most frequent complications associated with P. vivax infection. Ninety-one children hospitalized with P. vivax monoinfections but not requiring ICU were consecutively recruited in a tertiary care hospital for infectious diseases to serve as a reference population (comparators). Male sex (p = 0.039), age less than five years (p = 0.028), parasitemia greater than 500/mm(3) (p = 0.018), and the presence of any acute (p = 0.023) or chronic (p = 0.017) co-morbidity were independently associated with ICU admission. At least one of the WHO severity criteria for malaria (formerly validated for P. falciparum) was present in 23/24 (95.8%) of the patients admitted to the ICU and in 17/91 (18.7%) of controls, making these criteria a good predictor of ICU admission (p = 0.001). The only investigated criterion not associated with ICU admission was hyperbilirubinemia (p = 0.513)]. CONCLUSIONS: Our study points to the importance of P. vivax-associated severe disease in children, causing 72.5% of the malaria admissions to pediatric ICUs. WHO severity criteria demonstrated good sensitivity in predicting severe P. vivax infection in this small case series

Micronutrient deficiencies and plasmodium vivax malaria among children in the Brazilian Amazon

Background: There is a growing body of evidence linking micronutrient deficiencies and malaria incidence arising mostly from P. falciparum endemic areas. We assessed the impact of micronutrient deficiencies on malaria incidence and vice versa in the Brazilian state of Amazonas. Methodology/Principal Findings: We evaluated children <10 years old living in rural communities in the state of Amazonas, Brazil, from May 2010 to May 2011. All children were assessed for sociodemographic, anthropometric and laboratory parameters, including vitamin A, beta-carotene, zinc and iron serum levels at the beginning of the study (May 2010) and one year later (May 2011). Children were followed in between using passive surveillance for detection of symptomatic malaria. Those living in the study area at the completion of the observation period were reassessed for micronutrient levels. Univariate Cox-proportional Hazards models were used to assess whether micronutrient deficiencies had an impact on time to first P. vivax malaria episode. We included 95 children median age 4.8 years (interquartile range [IQR]: 2.3-6.6), mostly males (60.0%) and with high maternal illiteracy (72.6%). Vitamin A deficiencies were found in 36% of children, beta-carotene deficiency in 63%, zinc deficiency in 61% and iron deficiency in 51%. Most children (80%) had at least one intestinal parasite. During follow-up, 16 cases of vivax malaria were diagnosed amongst 13 individuals. Micronutrient deficiencies were not associated with increased malaria incidence: vitamin A deficiency [Hazard ratio (HR): 1.51; P-value: 0.45]; beta-carotene [HR: 0.47; P-value: 0.19]; zinc [HR: 1.41; P-value: 0.57] and iron [HR: 2.31; P-value: 0.16]). Upon reevaluation, children with al least one episode of malaria did not present significant changes in micronutrient levels. Conclusion: Micronutrient serum levels were not associated with a higher malaria incidence nor the malaria episode influenced micronutrient levels. Future studies targeting larger populations to assess micronutrients levels in P. vivax endemic areas are warranted in order to validate these results. © 2016 Benzecry et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Impacto da malária sobre o estado nutricional e micronutrientes (vitamina a, betacaroteno, zinco e ferro) de uma coorte de crianças no estado do Amazonas

Background. There is a growing body of evidence linking micronutrient deficiencies and malaria incidence arising mostly from P. falciparum endemic areas. We assessed the impact of micronutrient deficiencies on malaria vivax incidence and vice versa in the Brazilian state of Amazonas. Methodology/Principal Findings. We evaluated children <10 years old living in rural communities in the state of Amazonas, Brazil, from May 2010 to May 2011. All children were assessed for sociodemographic, anthropometric and laboratory parameters, including vitamin A, beta-carotene, zinc and iron serum levels at the beginning of the study (May 2010) and one year later (May 2011). Children were followed in between using passive surveillance for detection of symptomatic malaria. Those living in the study area at the completion of the observation period were reassessed for micronutrient levels. Univariate Cox-proportional Hazards models were used to assess whether micronutrient deficiencies had an impact on time to first P. vivax malaria episode. We included 95 children median age 4.8 years (interquartile range [IQR]: 2.3?6.6), mostly males (60.0%) and with high maternal illiteracy (72.6%). Vitamin A deficiencies were found in 36% of children, beta-carotene deficiency in 63%, zinc deficiency in 61% and iron deficiency in 51%. Most children (80%) had at least one intestinal parasite. During follow-up, 16 cases of vivax malaria were diagnosed amongst 13 individuals. Micronutrient deficiencies were not associated with increased malaria incidence: vitamin A deficiency [Hazard ratio (HR): 1.51; P-value: 0.45]; beta-carotene [HR: 0.47; P-value: 0.19]; zinc [HR: 1.41; P-value: 0.57] and iron [HR: 2.31; P-value: 0.16]). Upon reevaluation, children with al least one episode of malaria did not present significant changes in micronutrient levels. Conclusion. Micronutrient serum levels were not associated with a higher malaria incidence nor the malaria episode influenced micronutrient levels. Future studies targeting larger populations to assess micronutrients levels in P. vivax endemic areas are warranted in order to validate these results.Introdução. Existe crescente número de evidências que relacionam as deficiências de micronutrientes e a incidência da malária, decorrente principalmente do Plasmodium falciparum. O objetivo deste estudo foi avaliar o impacto das deficiências de micronutrientes sobre a incidência da malária vivax e vice-versa, no estado brasileiro do Amazonas. Método/Principais resultados: Foram avaliadas crianças <10 anos de idade que vivem em comunidades rurais do Estado do Amazonas, Brasil, no período de maio de 2010 a maio de 2011. As crianças foram acompanhadas por 12 meses e realizaram gota espessa por meio de detecção passiva e febre a qualquer momento durante o estudo. Depois do seguimento de 12 meses, todas as crianças foram avaliadas novamente, a fim de detectar mudanças nos parâmetros das variáveis sociodemográficas, antropométricas e laboratoriais, incluindo a dosagem da vitamina A, beta-caroteno, zinco e ferro sérico associadas com a infecção da malária. O modelo de riscos proporcionais de Cox foi utilizado para avaliar se as deficiências de micronutrientes tiveram impacto sobre o tempo no primeiro episódio de malária P. vivax . Foram incluídas 95 crianças com média de idade de 4,8 anos (intervalo interquartil [IQR]: 2,3-6,6), em sua maioria do sexo masculino (60%) e com o índice de analfabetismo materno alta (72,6%). A deficiência de vitamina A foi encontradas em 36% das crianças, de beta caroteno em 63%, de zinco em 61% e deficiência de ferro em 51%. A maioria das crianças (80%) tiveram pelo menos um parasita intestinal. Durante o acompanhamento, 16 casos de malária vivax foram diagnosticados entre os 13 indivíduos. Não houve associação entre as deficiências dos micronutrientes e o aumento na incidência de malária. Deficiência de vitamina A [hazard ratio (HR): 1,51; p= 0,45]; beta-caroteno [RH: 0,47; p= 0,19]; zinco [HR: 1.41; p= 0,57] e ferro [HR: 2.31; p= 0,16]). Após a reavaliação, as crianças com pelo menos um episódio de malária não apresentaram alterações significativas nos níveis dos micronutrientes. Conclusões. Os níveis dos micronutrientes não foram associados com uma maior incidência de malária vivax, nem houve influência dos níveis de micronutrientes nos episódios de malária. São necessários para validar esses resultados estudos futuros visando avaliar os níveis de micronutrientes em um número maior de pacientes nas áreas endêmicas de P. vivax.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

The effect of dietary intervention on mutritional status of children with heart diseases

Objetivos: Avaliar o efeito da orientacao dietetica sobre a inGestão de nutrientes e o estado nutricional de criancas cardiopatas. Metodo: estudo clinico-epidemiologico do tipo coorte, realizado no periodo de 6 meses, em 35 criancas cardiopatas pre-puberes com idade entre 0 e 14 anos. Nao foram incluidas criancas em aleitamento materno exclusivo, com peso de nascimento abaixo de 1500g, cirurgia corretiva total, sopro inocente ou sindromes e doencas cronicas que nao cardiopatia. A avaliacao nutricional constou de inquerito alimentar dia habitual, e escores Z de peso/idade, peso/estatura e estatura/idade , utilizando-se o padrao de referencia da OMS. A orientacao dietetica foi personalizada, sendo as falhas quantitativas e qualitativas na dieta corrigidas gradualmente, em acompanhamento mensal. O calculo das recomendacoes nutricionais baseou-se no RDA (1989) e a padronizacao de conduta nutricional para desnutridos, na WHO (1999). Resultados: A prevalencia de disturbios nutricionais foi de 77,1 por cento, sendo maior no grupo de cianoticos (60 por cento) e com insufiCiência cardiaca congestiva descompensada (100 por cento). O retardo de crescimento foi mais prevalente nos grupos de cianoticos (59 por cento), com hipertensao pulmonar (67 por cento) e insufiCiência cardiaca congestiva descompensada (75 por cento). Ao final do acompanhamento houve melhora significante dos escores Z de P/I (---- ± vs ---- ± , p< 0.02), PIE (----± vs ----- ± , p< 0.06) e E/I ( ---- ± vs ---- ± p< 0.06). A velocidade de crescimento esteve dentro dos limites da normalidade durante o periodo de estudo. A inGestão de energia, de vitaminas e de .... situou-se abaixo da recomendada. Houve melhora significante da inGestão lipidica, vitaminas C, A, E, tiamina, Ferro e zinco; e tendencia a melhora da inGestão proteica. Nao houve alteracao significante nas ingestoes de energia, calcio, fosforo e magnesio. Conclusao: O acompanhamento e a orientacao dietetica de criancas cardiopatas melhorou a inGestão de nutrientes e o estado nutricionalBV UNIFESP: Teses e dissertaçõe

Hipofosfatemia em crianças gravemente doentes

The purpose of this paper is to review clinical studies on hypophosphatemia in pediatric intensive care unit patients with a view to verifying prevalence and risk factors associated with this disorder. We searched the computerized bibliographic databases Medline, Embase, Cochrane Library, and LILACS to identify eligible studies. Search terms included critically ill, pediatric intensive care, trauma, sepsis, infectious diseases, malnutrition, inflammatory response, surgery, starvation, respiratory failure, diuretic, steroid, antiacid therapy, mechanical ventilation. The search period covered those clinical trials published from January 1990 to January 2004. Studies concerning endocrinological disorders, genetic syndromes, rickets, renal diseases, anorexia nervosa, alcohol abuse, and prematurity were not included in this review. Out of 27 studies retrieved, only 8 involved pediatric patients, and most of these were case reports. One clinical trial and one retrospective study were identified. The prevalence of hypophosphatemia exceeded 50%. The commonly associated factors in most patients with hypophosphatemia were refeeding syndrome, malnutrition, sepsis, trauma, and diuretic and steroid therapy. Given the high prevalence, clinical manifestations, and multiple risk factors, the early identification of this disorder in critically ill children is crucial for adequate replacement therapy and also to avoid complications.Este estudo objetivou realizar revisão da literatura para verificar prevalência, fatores de risco e condições clínicas associadas à hipofosfatemia em crianças gravemente doentes. Para a pesquisa foram utilizadas as bases de dados Medline, Embase, Cochrane Library, Lilacs abrangendo estudos clínicos publicados de janeiro de 1990 a janeiro de 2004. Os termos utilizados para pesquisa foram: critically ill, pediatric intensive care, trauma, sepsis, infectious diseases, malnutrition, inflammatory response, surgery, starvation, respiratory failure, diuretic, steroid, antiacid therapy, mechanical ventilation. Foram excluídos estudos referentes a distúrbios endócrinos, síndromes genéticas, raquitismo, nefropatias, anorexia nervosa, alcoolismo e prematuridade. Dos 27 artigos inicialmente identificados, 8 referiam-se à faixa etária pediátrica, sendo a maioria deles relatos de casos isolados. Nos estudos clínicos selecionados, a prevalência de hipofosfatemia foi superior a 50%. Os principais fatores associados à hipofosfatemia foram realimentação, desnutrição, sepse, trauma, uso de diuréticos e corticoesteróides. Considerando-se a elevada prevalência, as repercussões clínicas e os múltiplos fatores de risco para hipofosfatemia em crianças internadas em unidade de cuidados intensivos, a identificação precoce de pacientes suscetíveis a esse distúrbio é essencial para o tratamento oportuno e prevenção de complicações.Federal University of São Paulo Department of Pediatrics Pediatric Intensive Care UnitUNIFESP, Department of Pediatrics Pediatric Intensive Care UnitSciEL

Could Plasmodium vivax malaria trigger malnutrition? Revisiting the Bradford Hill criteria to assess a causal relationship between two neglected problems

Abstract: The benign characteristics formerly attributed to Plasmodium vivax infections have recently changed owing to the increasing number of reports of severe vivax malaria resulting in a broad spectrum of clinical complications, probably including undernutrition. Causal inference is a complex process, and arriving at a tentative inference of the causal or non-causal nature of an association is a subjective process limited by the existing evidence. Applying classical epidemiology principles, such as the Bradford Hill criteria, may help foster an understanding of causality and lead to appropriate interventions being proposed that may improve quality of life and decrease morbidity in neglected populations. Here, we examined these criteria in the context of the available data suggesting that vivax malaria may substantially contribute to childhood malnutrition. We found the data supported a role for P. vivax in the etiology of undernutrition in endemic areas. Thus, the application of modern causal inference tools, in future studies, may be useful in determining causation

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Correlation between parasitemia and hemoglobin.

<p>Correlation between parasitemia and hemoglobin during the first malarial attack in children without helminthes (A) and with helminthes (B).</p

Algorithm of the study, describing the details of eligible, enrolled and analyzed children.

<p>Algorithm of the study, describing the details of eligible, enrolled and analyzed children.</p