Changes in serum lipid profile in the acute and convalescent Plasmodium vivax malaria: A cohort study
Graphical abstract
Introduction
In 2013, almost 180,000 cases of malaria were reported in Brazil, 99.7% of which occurred in the Amazon region. Most of these cases (85.7%) were caused by Plasmodium vivax. Although P. vivax-induced malaria is generally a benign disease, it is increasingly being associated with severe evolution and fatal outcomes (Rogerson and Carter, 2008, Singh et al., 2011). Fever is still the most frequent symptom in malaria, followed by headache, chills, myalgia, diarrhea, and intense weakness. More severe complications, which commonly occur in Plasmodium falciparum infection, include profound anemia, hypoglycemia, hypotension, severe hemolysis, metabolic acidosis, acute renal failure, acute pulmonary edema, and coma (WHO, 2000). All of these complications have been reported in P. vivax infection albeit less frequently (Rahimi et al., 2014).
The inflammatory phase of various pathological conditions such as acute infections (Luthold et al., 2007), traumas (Akgün et al., 1998), burns (Coombes et al., 1980) and myocardial ischemia (Kittl et al., 1992) involves transient and moderate changes in serum lipid concentrations. Despite the extensive evidence indicating serum lipids are altered in P. falciparum malaria (Baptista et al., 1996, Al-Omar et al., 2010, Jacob, 2014), similar information about P. vivax malaria from clinical practice is scarce (Krishna and Chandrika, 2009). In addition, few studies have evaluated the behaviors of these lipid changes after antimalarial treatment (Kim et al., 2008). Hypothesizing that lipid changes were also present in vivax malaria, we designed this study to analyze the serum lipid concentrations in the acute phase of patients presenting with acute forms of P. vivax-induced malaria and characterized changes in the convalescent phase after specific antimalarial treatment.
Section snippets
Study design and patients
This was a descriptive cohort study of patients with P. vivax-induced malaria treated at the Infectious Diseases Clinic of Júlio Müller University Hospital between December 2011 and January 2015. This service is located in Cuiabá, State of Mato Grosso, Brazil and receives patients from different regions of the Brazilian Amazon where malaria is endemic.
Patients presenting with isolated P. vivax infection who voluntarily agreed to participate were included. Pregnant women and patients suffering
Results
From December 2011 to January 2015, 178 patients attended the Infectious Disease Clinic of Júlio Müller University Hospital. Among them, 164 (92.1%) presented with acute P. vivax infection and met the predefined inclusion criteria and were therefore included (Table 1). This sample size ensured a statistical power above 99% for the comparison of means between two groups for total cholesterol, HDL and LDL. The patients were mostly men (79.8%), with a mean age of 39.1 (14.9) years. Nearly all (n =
Discussion
Analysis of the lipid profile of patients presenting with symptomatic P. vivax infection showed that the serum levels of total cholesterol, HDL, and LDL were significantly reduced in the acute phase (i.e., pretreatment) and increased rapidly, tending to return to normal during the convalescent phase after specific antimalarial treatment. Meanwhile, the triglyceride serum level increased in the acute phase and decreased during the convalescent phase.
The present findings corroborate the notion
Conclusion
The serum concentrations of total cholesterol, HDL, and LDL are reduced and triglyceride are elevated in acute malaria induced by P. vivax. Furthermore, HDL and LDL are negatively correlated with parasite density. These lipid levels rapidly return to normal after antimalarial treatment initiation. This transient change in lipid profile between the acute and convalescent stages may be useful for the clinical monitoring of patients treated for vivax malaria. However, further studies are required
Conflict of interests
The authors declare no conflict of interests.
Acknowledgments
The authors thank to Brazilian Research Council CNPq and FAPEMAT for the financial support of this work and Editage (www.editage.com.br) for English language editing.
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