Epidemiologia de la malaria falciparum complicada: estudio de casos y controles en Tumaco y Turbo, Colombia, 2003 The epidemiology of complicated falciparum malaria: case and controls study in Tumaco and Turbo, Colombia, 2003 - Alberto Tobón C.; Carolina Giraldo S.; Juan Gabriel Pineros J.; Margarita Arboleda N.; Silvia Blair T.; Jaime Carmona-Fonseca (Associação Brasileira de Pós-Graduação em Saúde Coletiva, 2006)
OBJETIVOS: Identificar aspectos del hospedero, del parásito y del ambiente asociados con ocurrencia de malaria por Plasmodium falciparum complicada. MÉTODOS: Estudio de casos y controles en pacientes de Tumaco y Turbo (Colombia) aplicando los criterios de complicación de la Organización Mundial de la Salud. RESULTADOS: Entre noviembre 2002 y julio 2003 se captaron 64 casos (malaria complicada) y 135 controles (malaria no complicada). Las complicaciones fueron: hiperparasitemia (40%), falla hepática (36%), síndrome dificultad respiratoria aguda (7%), falla renal (4%), trombocitopenia grave (3%), anemia grave (2%), malaria cerebral (2%) e hipoglicemia grave (1%). Se encontraron como factores de riesgo para malaria falciparum complicada: a) Los antecedentes de malaria falciparum durante el último año fueron menores en los casos (OR= 7.0 (1.2-43.6) P=0.019); b) Mayor uso previo de antimaláricos en los casos (OR=2.2 (1.1-4.4) P=0.031) y c) mayor uso de cloroquina en los casos (OR=7.4 (1.1-7.8) P=0.017). Se hallaron los alelos MAD-20 y K1 del gen msp1 y FC-27 e IC-1 del gen msp2, cuya distribución de frecuencias fue similar entre casos y controles, aunque el alelo K1 mostró una variación importante entre grupos (casos: 9.4%, controles: 3.5%). La frecuencia de "signos de peligro" fue significativamente mayor en los casos (OR= 3.3, (1.5-7.4) P=0.001). Los criterios de complicación malárica de la Organización Mundial de la Salud se comparan con otros y se discuten algunas implicaciones. CONCLUSIÓN: Se identificaron como factores de riesgo para malaria falciparum complicada, la ausencia de antecedentes de malaria falciparum en el último año y el uso de antimaláricos antes de llegar al hospital. OBJECTIVES: Aimed at identifying host and parasite aspects associated to the presence of Plasmodium falciparum complicated malaria. METHODS: Case and controls study in patients from Tumaco and Turbo (Colombia). We used the World Health Organization criteria to assess the presence of complicated malaria. RESULTS: A total 64 cases and 135 controls were included between November 2002 and July 2003. Observed complications were hyperparasitaemia (40%), liver failure (36%), adult respiratory distress syndrome (7%), renal failure (4%), severe thrombocytopenia (3%), severe anemia (2%), cerebral malaria (2%) and severe hypoglicemia (1%). Were identified as risk factors: a) falciparum malaria history in the previous year was lower in the cases (OR= 7.0 (1.2-43.6) P=0.019), b) the high use by the cases of antimalarials (OR=2.2, (1.1-4.4) P=0.031) and c) the high use of chloroquine by the cases (OR=7.4 (1.1-7.8), P=0.017) before attending to the hospital. Presence of P. falciparum alleles MAD-20 and K1 (msp1 gene), FC-27 and IC-1 (msp2 gene) was confirmed. No significant differences were observed in the presence of these alleles; however K1 was more frequent in cases (9.4%) than in controls (3.5%). The frequency of danger signs during the disease was significantly greater in the cases (OR= 3.3 (1.5-7.4) P=0.001). The World Health Organization criteria for complicated malaria are compared with others and some implications are discussed. CONCLUSION: They were identified as risk factors for complicated falciparum malaria, the absence of falciparum malaria antecedents in the last year and the use of antimalarials before attending to the hospital.