Log in | Register

Cardiac function in Ghanaian children with severe malaria

Samuel B. Nguah| Torsten Feldt| Steffi Hoffmann| Daniel Pelletier| Daniel Ansong| Justice Sylverken| Parisa Mehrfar| Johanna Herr| Christian Thiel| Stephan Ehrhardt| Gerd D. Burchard| Jakob P. Cramer
Original
Volume 38, Issue 12 / December , 2012

Pages 2032 - 2041

Abstract

Purpose

The aim was to assess whether impaired cardiac function contributes to symptoms of severe malaria in general or to metabolic acidosis in particular in children living in endemic regions.

Methods

In a prospective observational investigation, 183 children with severe malaria were investigated for hemodynamic status and cardiac function upon admission (day 0) and after recovery (day 42). Cardiac function parameters were assessed by cardiac ultrasonography. Blood gas analyses and cardiac enzymes were measured at hospitalization and follow-up. Differences in subgroups with and without metabolic acidosis as well as other severe malaria-defining symptoms and conditions were assessed.

Results

Cardiac index (CI) was significantly increased on day 0 compared to day 42 (5.8 ml/m2, SD ± 1.8 ml/m2, versus 4.7 ml/m2, SD ± 1.4 ml/m2; P < 0.001). CI correlated negatively with hemoglobin levels but not with parameters indicating impaired tissue perfusion or metabolic acidosis. Parasite levels had a significant influence on metabolic acidosis but not on CI. Alterations related to cardiac function, hemoglobin levels and metabolic acidosis were most prominent in children younger than 2 years.

Conclusion

Increased CI reflecting high output status is associated with low hemoglobin levels while metabolic acidosis is linked to parasite levels.

Keywords

References

  1. Merx MW, Weber C (2007) Sepsis and the heart. Circulation 116:793–802
    • View reference on PubMed
    • View reference on publisher's website
  2. Brierley J, Carcillo JA, Choong K, Cornell T, Decaen A, Deymann A, Doctor A, Davis A, Duff J, Dugas MA, Duncan A, Evans B, Feldman J, Felmet K, Fisher G, Frankel L, Jeffries H, Greenwald B, Gutierrez J, Hall M, Han YY, Hanson J, Hazelzet J, Hernan L, Kiff J, Kissoon N, Kon A, Irazuzta J, Lin J, Lorts A, Mariscalco M, Mehta R, Nadel S, Nguyen T, Nicholson C, Peters M, Okhuysen-Cawley R, Poulton T, Relves M, Rodriguez A, Rozenfeld R, Schnitzler E, Shanley T, Kache S, Skippen P, Torres A, von Dessauer B, Weingarten J, Yeh T, Zaritsky A, Stojadinovic B, Zimmerman J, Zuckerberg A (2009) Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med 37:666–688
    • View reference on PubMed
    • View reference on publisher's website
  3. Goldstein B, Giroir B, Randolph A (2005) International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6:2–8
    • View reference on PubMed
    • View reference on publisher's website
  4. Rivers EP, Jaehne AK, Eichhorn-Wharry L, Brown S, Amponsah D (2010) Fluid therapy in septic shock. Curr Opin Crit Care 16:297–308
    • View reference on PubMed
    • View reference on publisher's website
  5. Myburgh JA (2011) Fluid resuscitation in acute illness – time to reappraise the basics. N Engl J Med 364:2543–2544
    • View reference on PubMed
    • View reference on publisher's website
  6. Annane D, Bellissant E, Cavaillon JM (2005) Septic shock. Lancet 365:63–78
    • View reference on PubMed
    • View reference on publisher's website
  7. Clark IA, Alleva LM, Budd AC, Cowden WB (2008) Understanding the role of inflammatory cytokines in malaria and related diseases. Travel Med Infect Dis 6:67–81
    • View reference on PubMed
    • View reference on publisher's website
  8. Dondorp AM, Pongponratn E, White NJ (2004) Reduced microcirculatory flow in severe falciparum malaria: pathophysiology and electron-microscopic pathology. Acta Trop 89:309–317
    • View reference on PubMed
    • View reference on publisher's website
  9. Herr J, Mehrfar P, Schmiedel S, Wichmann D, Brattig NW, Burchard GD, Cramer JP (2011) Reduced cardiac output in imported Plasmodium falciparum malaria. Malar J 10:160
    • View reference on PubMed
    • View reference on publisher's website
  10. Yacoub S, Lang HJ, Shebbe M, Timbwa M, Ohuma E, Tulloh R, Maitland K (2010) Cardiac function and hemodynamics in Kenyan children with severe malaria. Crit Care Med 38:940–945
    • View reference on PubMed
    • View reference on publisher's website
  11. Ehrhardt S, Wichmann D, Hemmer CJ, Burchard GD, Brattig NW (2004) Circulating concentrations of cardiac proteins in complicated and uncomplicated Plasmodium falciparum malaria. Trop Med Int Health 9:1099–1103
    • View reference on PubMed
    • View reference on publisher's website
  12. Ehrhardt S, Mockenhaupt FP, Anemana SD, Otchwemah RN, Wichmann D, Cramer JP, Bienzle U, Burchard GD, Brattig NW (2005) High levels of circulating cardiac proteins indicate cardiac impairment in African children with severe Plasmodium falciparum malaria. Microbes Infect 7:1204–1210
    • View reference on PubMed
    • View reference on publisher's website
  13. Planche T (2005) Malaria and fluids – balancing acts. Trends Parasitol 21:562–567
    • View reference on PubMed
    • View reference on publisher's website
  14. Jarvis JN, Planche T, Bicanic T, Dzeing-Ella A, Kombila M, Issifou S, Borrmann S, Kremsner PG, Krishna S (2006) Lactic acidosis in Gabonese children with severe malaria is unrelated to dehydration. Clin Infect Dis 42:1719–1725
    • View reference on PubMed
    • View reference on publisher's website
  15. Akech S, Ledermann H, Maitland K (2010) Choice of fluids for resuscitation in children with severe infection and shock: systematic review. BMJ 341:c4416
    • View reference on PubMed
    • View reference on publisher's website
  16. World Health Organization, Communicable Diseases Cluster (2000) Severe falciparum malaria. Trans R Soc Trop Med Hyg 94(Suppl 1):S1–S90
    • View reference on publisher's website
  17. Evans JA, May J, Ansong D, Antwi S, Asafo-Adjei E, Nguah SB, Osei-Kwakye K, Akoto AO, Ofori AO, Sambian D, Sylverken J, Busch W, Timmann C, Agbenyega T, Horstmann RD (2006) Capillary refill time as an independent prognostic indicator in severe and complicated malaria. J Pediatr 149:676–681
    • View reference on PubMed
    • View reference on publisher's website
  18. Afrane YA, Klinkenberg E, Drechsel P, Owusu-Daaku K, Garms R, Kruppa T (2004) Does irrigated urban agriculture influence the transmission of malaria in the city of Kumasi, Ghana? Acta Trop 89:125–134
    • View reference on PubMed
    • View reference on publisher's website
  19. Kobbe R, Kreuzberg C, Adjei S, Thompson B, Langefeld I, Thompson PA, Abruquah HH, Kreuels B, Ayim M, Busch W, Marks F, Amoah K, Opoku E, Meyer CG, Adjei O, May J (2007) A randomized controlled trial of extended intermittent preventive antimalarial treatment in infants. Clin Infect Dis 45:16–25
    • View reference on PubMed
    • View reference on publisher's website
  20. Mosteller RD (1987) Simplified calculation of body-surface area. N Engl J Med 317:1098
    • View reference on PubMed
  21. Mehta PA, Dubrey SW (2009) High output heart failure. QJM 102:235–241
    • View reference on PubMed
    • View reference on publisher's website
  22. Murphy S, Cserti-Gazdewich C, Dhabangi A, Musoke C, Nabukeera-Barungi N, Price D, King ME, Romero J, Noviski N, Dzik W (2011) Ultrasound findings in Plasmodium falciparum malaria: a pilot study. Pediatr Crit Care Med 12:e58–e63
    • View reference on PubMed
    • View reference on publisher's website
  23. Anand IS (2010) Pathophysiology of anemia in heart failure. Heart Fail Clin 6:279–288
    • View reference on PubMed
    • View reference on publisher's website
  24. Wichmann D, Schwarz RT, Ruppert V, Ehrhardt S, Cramer JP, Burchard GD, Maisch B, Debierre-Grockiego F (2007) Plasmodium falciparum glycosylphosphatidylinositol induces limited apoptosis in liver and spleen mouse tissue. Apoptosis 12:1037–1041
    • View reference on PubMed
    • View reference on publisher's website
  25. Wennicke K, Debierre-Grockiego F, Wichmann D, Brattig NW, Pankuweit S, Maisch B, Schwarz RT, Ruppert V (2008) Glycosylphosphatidylinositol-induced cardiac myocyte death might contribute to the fatal outcome of Plasmodium falciparum malaria. Apoptosis 13:857–866
    • View reference on PubMed
    • View reference on publisher's website
  26. Domico M, Liao P, Anas N, Mink RB (2008) Elevation of brain natriuretic peptide levels in children with septic shock. Pediatr Crit Care Med 9:478–483
    • View reference on PubMed
    • View reference on publisher's website
  27. Zanotti-Cavazzoni SL, Hollenberg SM (2009) Cardiac dysfunction in severe sepsis and septic shock. Curr Opin Crit Care 15:392–397
    • View reference on PubMed
    • View reference on publisher's website
  28. Janka JJ, Koita OA, Traore B, Traoré JM, Mzayek F, Sachdev V, Wang X, Sanogo K, Sangaré L, Mendelsohn L, Masur H, Kato GJ, Gladwin MT, Krogstad DJ (2010) Increased pulmonary pressures and myocardial wall stress in children with severe malaria. J Infect Dis 202:791–800
    • View reference on PubMed
    • View reference on publisher's website
  29. Cramer JP, Nussler AK, Ehrhardt S, Burkhardt J, Otchwemah RN, Zanger P, Dietz E, Gellert S, Bienzle U, Mockenhaupt FP (2005) Age-dependent effect of plasma nitric oxide on parasite density in Ghanaian children with severe malaria. Trop Med Int Health 10:672–680
    • View reference on PubMed
    • View reference on publisher's website
  30. Maitland K, Kiguli S, Opoka RO, Engoru C, Olupot-Olupot P, Akech SO, Nyeko R, Mtove G, Reyburn H, Lang T, Brent B, Evans JA, Tibenderana JK, Crawley J, Russell EC, Levin M, Babiker AG, Gibb DM; FEAST Trial Group (2011) Mortality after fluid bolus in African children with severe infection. N Engl J Med 364:2483–2495
    • View reference on PubMed
    • View reference on publisher's website
  31. Dondorp AM, Ince C, Charunwatthana P, Hanson J, van Kuijen A, Faiz MA, Rahman MR, Hasan M, Bin Yunus E, Ghose A, Ruangveerayut R, Limmathurotsakul D, Mathura K, White NJ, Day NP (2008) Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria. J Infect Dis 197:79–84
    • View reference on PubMed
    • View reference on publisher's website
  32. Marks F, Adu-Sarkodie Y, Hunger F, Sarpong N, Ekuban S, Agyekum A, Nkrumah B, Schwarz NG, Favorov MO, Meyer CG, May J (2010) Typhoid fever among children, Ghana. Emerg Infect Dis 16:1796–1797
    • View reference on PubMed
    • View reference on publisher's website
  33. English M, Muambi B, Mithwani S, Marsh K (1997) Lactic acidosis and oxygen debt in African children with severe anaemia. QJM 90:563–569
    • View reference on PubMed
    • View reference on publisher's website

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement