To evaluate epidemiological, clinical and laboratory features of Plasmodium vivax malaria in children and adolescents. Methods: This study was carried out in the Malaria Program of the Evandro Chagas Institute (Belém, Brazil), from January 1995 to November 1996, and randomly enrolled 100 children and adolescents with the diagnosis of P. vivax malaria (thick blood film). A protocol was created to assess epidemiological, clinical and laboratory parameters of this pathology. Results: Malaria occurred in both sexes, and was prevalent among adolescents (37%). Most of the children and adolescents (92%) had been infected in the State of Pará. Autochthonous cases in the metropolitan area of Belém accounted for 34% of all the cases. Primary infection was seen in 80% of the patients. Fever was the most frequent initial clinical symptom (88%). Only 25% of the patients had a history of typical febrile paroxysm. Clinical findings on the first day of treatment (D0) were fever (97%), chills (91%), pallor (85%), splenomegaly (46%) and hepatomegaly (29%). Pallor (a clinical signal) was significantly (P=0.0004) associated with anemia (hemoglobin rate). There was a highly significant negative correlation (P=0.0001) between delay of diagnosis (mean 12.5 days) and hemoglobin values. Only children and adolescents with positive results to hookworms at parasitological examination were significantly (P=0.0133, P=0.0075) more anemic than those who had a positive parasitological examination for other helminths and/or protozoa species. Conclusions: Malaria affected children and adolescents from both sexes. Epidemiological and clinical data are important tools for the early diagnosis of the disease. Delayed diagnosis contributed to worsened anemia.
MethodsThis study was carried out in the Malaria Program of the Evandro Chagas Institute (Belém, Brazil), from January 1995 to November 1996, and randomly enrolled 100 children and adolescents with the diagnosis of P. vivax malaria (thick blood film). A protocol was created to assess epidemiological, clinical and laboratory parameters of this pathology. Results: Malaria occurred in both sexes, and was prevalent among adolescents (37%). Most of the children and adolescents (92%) had been infected in the State of Pará. Autochthonous cases in the metropolitan area of Belém accounted for 34% of all the cases. Primary infection was seen in 80% of the patients. Fever was the most frequent initial clinical symptom (88%). Only 25% of the patients had a history of typical febrile paroxysm. Clinical findings on the first day of treatment (D0) were fever (97%), chills (91%), pallor (85%), splenomegaly (46%) and hepatomegaly (29%). Pallor (a clinical signal) was significantly (P=0.0004) associated with anemia (hemoglobin rate). There was a highly significant negative correlation (P=0.0001) between delay of diagnosis (mean 12.5 days) and hemoglobin values. Only children and adolescents with positive results to hookworms at parasitological examination were significantly (P=0.0133, P=0.0075) more anemic than those who had a positive parasitological examination for other helminths and/or protozoa species. Conclusions: Malaria affected children and adolescents from both sexes. Epidemiological and clinical data are important tools for the early diagnosis of the disease. Delayed diagnosis contributed to worsened anemia.
ResultsMalaria occurred in both sexes, and was prevalent among adolescents (37%). Most of the children and adolescents (92%) had been infected in the State of Pará. Autochthonous cases in the metropolitan area of Belém accounted for 34% of all the cases. Primary infection was seen in 80% of the patients. Fever was the most frequent initial clinical symptom (88%). Only 25% of the patients had a history of typical febrile paroxysm. Clinical findings on the first day of treatment (D0) were fever (97%), chills (91%), pallor (85%), splenomegaly (46%) and hepatomegaly (29%). Pallor (a clinical signal) was significantly (P=0.0004) associated with anemia (hemoglobin rate). There was a highly significant negative correlation (P=0.0001) between delay of diagnosis (mean 12.5 days) and hemoglobin values. Only children and adolescents with positive results to hookworms at parasitological examination were significantly (P=0.0133, P=0.0075) more anemic than those who had a positive parasitological examination for other helminths and/or protozoa species. Conclusions: Malaria affected children and adolescents from both sexes. Epidemiological and clinical data are important tools for the early diagnosis of the disease. Delayed diagnosis contributed to worsened anemia.
ConclusionsMalaria affected children and adolescents from both sexes. Epidemiological and clinical data are important tools for the early diagnosis of the disease. Delayed diagnosis contributed to worsened anemia.
Avaliação dos aspectos epidemiológicos, clínicos e laboratoriais da malária por Plasmodium vivax em crianças e adolescentes.
MétodosNo ambulatório do Programa de Malária do Instituto Evandro Chagas (Belém-Pará), no período de janeiro de 1995 a novembro de 1996, foram estudadas de modo aleatório 100 crianças e adolescentes com diagnóstico positivo por gota espessa para malária por P. vivax. Elaborou-se um protocolo para avaliação dos aspectos epidemiológicos, clínicos e laboratoriais dessa patologia.
ResultadosAcometimento de ambos os sexos, com predomínio entre os adolescentes (37%). As crianças e adolescentes em sua maioria (92%) adquiriram a infecção no Pará. Os casos autóctones, área metropolitana de Belém, representaram 34% da amostra. Primoinfecção ocorreu em 80% dos pacientes. Febre foi a manifestação clínica inicial mais freqüente (88%). Relato de paroxismo febril típico (febre terçã) foi obtido em somente 25% da casuística. No 1º dia de tratamento (D0) febre (97%), calafrio (91%), palidez (85%), esplenomegalia (46%) e hepatomegalia (29%) foram alguns dos sinais e sintomas observados. Houve significância estatística (p=0,0004) na correlação entre palidez (avaliação clínica) e anemia (taxa de hemoglobina). Verificou-se uma correlação negativa altamente significativa (p=0,0001) entre o retardo diagnóstico (média de 12,5 dias) e os níveis de hemoglobina. Em relação ao exame parasitológico de fezes, somente crianças e adolescentes com resultado positivo para ancilostomídeos foram significativamente mais anêmicas (p=0,0133, p=0,0075) quando comparadas com aquelas com exame coprológico positivo para outros helmintos e/ou protozoários.
ConclusõesA malária acometeu crianças e adolescentes de ambos os sexos. A valorização de dados epidemiológicos e clínicos contribui para o diagnóstico precoce da doença. O retardo diagnóstico influenciou no agravamento da anemia.
