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Meta-Analysis
. 2020 Jun 19;15(6):e0235014.
doi: 10.1371/journal.pone.0235014. eCollection 2020.

Severity and mortality of severe Plasmodium ovale infection: A systematic review and meta-analysis

Manas Kotepui  1 , Kwuntida Uthaisar Kotepui  1 , Giovanni D Milanez  2 , Frederick R Masangkay  2
Affiliations
Meta-Analysis

Severity and mortality of severe Plasmodium ovale infection: A systematic review and meta-analysis

Manas Kotepui et al. PLoS One. .

Abstract

Plasmodium ovale can infect humans, causing malaria disease. We aimed to investigate the severity and mortality of severe P. ovale infection to increase the awareness of physicians regarding the prognosis of this severe disease and outcome-related deaths in countries in which this disease is endemic. Articles that were published in the PubMed, Scopus, and ISI Web of Science databases prior to January 5, 2020 and reported the prevalence of severe P. ovale infection were systematically searched and reviewed. Studies that mainly reported severe P. ovale infection according to the 2014 WHO criteria for the treatment of malaria were included. Two reviewers selected, identified, assessed, and extracted data from studies independently. The pooled prevalence of severe P. ovale mono-infections was estimated using the command "metaprop case population, random/fixed", which yielded the pooled estimate, 95% confidence interval (CI) and the I2 value, indicating the level of heterogeneity. Meta-analyses of the proportions were performed using a random-effects model to explore the different proportions of severity between patients with P. ovale and those with other Plasmodium species infections. Among the eight studies that were included and had a total of 1,365 ovale malaria cases, the pooled prevalence of severe P. ovale was 0.03 (95% CI = 0.03-0.05%, I2 = 54.4%). Jaundice (1.1%), severe anemia (0.88%), and pulmonary impairments (0.59%) were the most common severe complications found in patients infected with P. ovale. The meta-analysis demonstrated that a smaller proportion of patients with P. ovale than of patients with P. falciparum had severe infections (P-value = 0.01, OR = 0.36, 95% CI = 0.16-0.81, I2 = 72%). The mortality rate of severe P. ovale infections was 0.15% (2/1,365 cases). Although severe complications of P. ovale infections in patients are rare, it is very important to increase the awareness of physicians regarding the prognosis of severe P. ovale infections in patients, especially in a high-risk population.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram.
Flow chart of the study selection process.
Fig 2
Fig 2. Pooled prevalence of severe P. ovale infections.
Forest plot comparing the proportions of severe P. ovale cases and P. vivax cases.
Fig 3
Fig 3. Forest plot comparing severe P. ovale cases and P. falciparum cases.
The forest plot compared the proportions of patients with severe P. ovale infections with that of patients with P. falciparum infections.
Fig 4
Fig 4. Forest plot comparing severe P. ovale cases and P. vivax cases.
The forest plot compared the proportions of severe P. ovale cases and P. vivax cases.
Fig 5
Fig 5. Forest plot comparing severe P. ovale cases and P. malariae cases.
Forest plot comparing the proportion of patients with severe P. ovale cases and the proportion of patients with P. malaria cases.
See this image and copyright information in PMC

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