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. 2014 Jun 30;1(1):ofu034.
doi: 10.1093/ofid/ofu034. eCollection 2014 Mar.

Severe morbidity and mortality risk from malaria in the United States, 1985-2011

Jimee Hwang  1 , Karen A Cullen  2 , S Patrick Kachur  2 , Paul M Arguin  2 , J Kevin Baird  3
Affiliations

Severe morbidity and mortality risk from malaria in the United States, 1985-2011

Jimee Hwang et al. Open Forum Infect Dis. .

Abstract

Background: Recent reports of Plasmodium vivax associated with severe syndromes and mortality from malaria endemic areas questions the "benign" course of non-falciparum malarias.

Methods: We retrospectively analyzed data from patients reported to the US Centers for Disease Control and Prevention with a diagnosis of malaria parasite single-species infection between 1985 and 2011. Patients classified as having severe illness were further classified according to outcome (survival versus death) and clinical syndrome.

Results: Among all cases, .9% of Plasmodium falciparum cases resulted in death and 9.3% were classified as severe, whereas .09% of P. vivax cases resulted in death and 1.3% were classified as severe. The odds ratios for severe illness among 15 272 diagnoses of P. falciparum relative to patients diagnosed with P. vivax (n = 12 152), Plasmodium malariae (n = 1254), or Plasmodium ovale (n = 903) was 7.5, 5.7, and 5.0, respectively (P < .0001 for all); in contrast, the corresponding odds ratios for death among those severely ill was 1.6, 1.1, and .8 (P > .1 for all), respectively. Compared with P. vivax (n = 163), the odds of P. falciparum cases classified as severely ill (n = 1416) were 1.9 (P = .0006), .5 (P = .001), and 1.3 times (P = .1) as likely to present as cerebral, acute respiratory distress, and renal syndromes, respectively.

Conclusions: Although less common, patients presenting with non-falciparum even in the United States can develop severe illness, and severe illness in patients having malaria of any species threatens life.

Keywords: Plasmodium; USA; morbidity; mortality; species.

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Figures

Figure 1.
Figure 1.
Annual number of cases of malaria reported in the United States from 1985 to 2011, by species.
Figure 2.
Figure 2.
Percentage of Plasmodium falciparum and P. vivax cases reported in the United States classified as severe, 1985–2011. Bars above and below points represent the error bars of a sensitivity analysis where cases of unknown species daignosis were counted as either all P. falciparum or all P. vivax.
Figure 3.
Figure 3.
Proportion of all cases between 2008 and 2011 classified as severe, and the odds ratio for that classification in Plasmodium falciparum compared with P. vivax, P. malariae, or P. ovale.
Figure 4.
Figure 4.
Annual number of severe Plasmodium falciparum and Plasmodium vivax cases, and odds ratio for a classification of severe illness with diagnosis of P. falciparum compared with P. vivax among cases in the United States between 1985 and 2011. The odds ratio for 1985 and 1993 were 82.2 and 61.3, respectively, and are not plotted.
See this image and copyright information in PMC

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