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Table 2 Clinical details of the patients whose deaths were associated with vivax malaria

From: Mortality attributable to Plasmodium vivaxmalaria: a clinical audit from Papua, Indonesia

Category

No.

Age

Time to death

Weight (kg)

Documented malnutrition

Documented Pv in last year

Vivax parasitaemia

Haemoglobin (g/dL)

White cell count (μl -1)

Platelets × 10 3 μl -1

Bilirubin (mmol/L)

Creatinine (μmol/L)

Glucose (mmol/L)

Bicarbonate (mmol/L)

CXR

Individual assessors’ classifications

Primary cause of death

Indirect causes

1. Primary cause

1

19y

1d

40

N

2

++++

2.2

7,000

11

135.6

105

8.2

-

-

1,1,1

Vivax malaria with extreme anaemia associated with hyperbilirubinaemia

 

2a

1y7m

1d

7

Y

1

++

4.7

8,000

142

-

-

-

-

-

1,1,1

Vivax malaria

Malnutrition

3

24y

4d

56

N

0

++++

2.6

16100

51

29.2

248

6.1

-

Resolving minor RLL consolidation compared with film 1 month prior

1,1,1

Vivax malaria with extreme anaemia and renal failure

 

4b

10 m

3d

7

Y

0

++++

1.9

11,800

64

-

-

13.5

3.0

Day 0 – normal Day 2 – whiteout of R lung and part of L lung. Pulmonary oedema in remainder of L lung

1,1,1

Vivax malaria with extreme anaemia and respiratory distress associated with acidosis

Malnutrition

5

1y9m

2d

11

N

0

++++

1.7

20,100

139

116.3

-

5.6

-

-

1,1,1

Vivax malaria with extreme anaemia associated with hyperbilirubinaemia

Possible underlying sepsis

2. Major contributor

6

3m26d

5 h

-

N

0

+

2.8

29,000

123

-

-

6.5

-

Normal

1,1,2

Vivax malaria with extreme anaemia

Possible underlying sepsis

7a

4y4m

2d

10

Y

0

++++

8.6

14,300

13

13.5

-

4.8

-

Normal

2,2,2

Respiratory tract infection

Malnutrition Vivax malaria

8a

3y1m

3 h

12

N

0

++

-

-

-

-

-

-

-

Normal

2,2,2

Respiratory tract infection

Vivax malaria

9

1y9m

7d

8

Y

3

+++

9.2

11,000

163

-

-

-

-

-

1,2,2

Malnutrition with sepsis

Vivax malaria

10

1y8m

4d

8

Y

0

++++

5.1

4,200

154

-

-

-

-

Poor inspiratory effort, unable to assess

2,2,2

Respiratory tract infection

Malnutrition Vivax malaria

11

1y8m

1d

-

Y

0

+++

7.3

13,900

13

-

56

21.8

 

Normal

1,2,3

Respiratory tract infection

Vivax malaria Malnutrition

12a

1y3m

9d

6

Y

3

+++

12.5

25,300

136

5.3

-

6.8

 

-

2,2,3

Diarrhoeal disease

Malnutrition Vivax malaria

13

1y

7d

6

Y

0

++

7.9

8,300

105

-

43

4.6

9.8

Normal

3,2,2

Diarrhoeal disease associated with acidosis

Vivax malaria Malnutrition

14

38y

13d

26

Y

0

+++

6.3

14,300

55

-

106

6.0

-

Minor chronic changes in LLL

2,2,2

AIDS

Vivax malaria Malnutrition

15

2y

2d

12

Y

0

+

4.4

10,600

21

23.4

48

4.3

26.7

Evidence of pneumonia

2,2,2

Respiratory tract infection

Vivax malaria Malnutrition

16

1y5m

17d

5

Y

3

++

6.7

9,500

262

-

-

6.0

-

Diffuse changes consistent with pneumonia, R > L

2,2,2

AIDS

Vivax malaria Malnutrition Tuberculosis

17

27y

5d

-

N

1

+

6.5

3,800

80

-

-

-

19.2

-

2,2,2

AIDS

Vivax malaria

18

1y23d

6 h

9

N

0

+++

5.8

4,700

229

-

44

8.7

9.3

RUL consolidation

2,2,2

Bronchopneumonia associated with acidosis

Vivax malaria

19

34y

8 h

50

N

0

++

5.8

14,100

252

-

-

4.9

2.2

Bilaterally increased lung markings, R > L, consistent with ARDS or pneumonia

2,2,2

Chronic renal failure associated with acidosis

Vivax malaria Respiratory tract infection

20b

61y

6d

50

N

0

+

4.1

3,500

9

21.7

2378

5.3

13.6

RML collapse with consolidation, calcification and scarring

2,2,2

Chronic renal failure with respiratory tract infection associated with acidosis

Vivax malaria

21a,b

25y

5 h

75

N

0

+

6.2

23,700

22

-

97

15.4

-

-

2,2,2

GI bleeding secondary to NSAID

Vivax malaria

22b

3y

1d

11

N

0

++

9.4

9,600

152

-

114

1.7

13.3

Admission – underexposed but probably normal Later in the day – collapsed L lung with ETT in R main bronchus. R lung normal

2,2,2

Sepsis associated with hypoglycaemia and acidosis

Vivax malaria Trauma

23b

14y

8d

-

N

0

+++

2.1

4,200

89

19.0

1680

-

2.2

-

2,2,3

Uraemia secondary to endstage chronic renal failure associated with acidosis

Vivax malaria exacerbating severe anaemia

3. Minor contributor

24

2y4m

6d

9

Y

1

++

13.0

12,600

231

40.4

-

6.9

-

-

2,3,3

Diarrhoeal disease

Sepsis Malnutrition Vivax malaria

25

59y

3d

50

N

0

+

10.5

35,500

173

33.5

228

4.2

-

-

3,3,3

Respiratory sepsis

COPD Vivax malaria Ischemic heart disease

26

2y10m

5d

12

Y

1

+

9.0

13200

124

-

12

5.8

22.8

Dense, bilateral patchy consolidation L > R

3,3,3

Tuberculosis with sepsis

Vivax malaria Malnutrition

27a

18y

1d

50

N

0

++

15.5

16,100

100

-

332

11.4

17.1

Normal

3,3,3

Meningitis associated with renal failure

Vivax malaria

28a

60y

1d

37

N

0

+

11.5

11,800

119

-

600

5.7

-

-

3,3,4

Hepatorenal syndrome

Vivax malaria Possible bacterial infection

29

1y8m

1d

7

N

1

++

9.8

79,300

580

-

-

2.4

9.9

CXR 2 days prior showed infiltrate obscuring L heart border

3,3,3

Respiratory tract infection with overwhelming sepsis and acidosis

Vivax malaria Malnutrition

30

24y

5d

33

N

2

+

4.7

1,500

85

6.7

132

5.7

21.9

Worsening RML consolidation and cavitation compared with previous films. L mid and lower zone consolidation and cavitation. R mediastinal mass

3,3,3

AIDS with tuberculosis

Vivax malaria

31

5m4d

12d

7

N

0

++

13.0

7,200

107

-

-

-

13.9

Infiltrate at R hilum

3,4,3

Bronchopneumonia associated with acidosis

Vivax malaria

32

1y8m

1d

6

Y

0

++++

10.2

19,700

110

-

66

1.2

-

Normal

3,3,3

Diarrhoeal disease with hypovolaemic shock

Vivax malaria Malnutrition

33

55y

4d

60

N

0

++++

10.1

19,500

55

-

521

3.7

-

Increased lung markings bilaterally

3,3,3

Sepsis and renal failure

Vivax malaria

34

4y

1d

16

N

0

+

11.2

22,700

461

-

-

6.0

-

-

3,3,3

GI sepsis

Vivax malaria

35

31y

10d

38

Y

1

+

9.9

3,700

114

3.4

131

4.6

-

-

3,3,3

HIV associated enteropathy

Malnutrition Vivax malaria

36

3y6m

15d

12

Y

2

++

8.9

27,700

3

63.3

-

-

33.2

Poor inspiratory effort, unable to assess

3,3,4

Respiratory tract infection with overwhelming sepsis associated with hyperbilirubinaemia

Malnutrition Vivax malaria

  1. aResearch microscopy done; bParacheck Pf® done. AIDS; acquired immunodeficiency syndrome, ARDS; acute respiratory distress syndrome, CXR; chest X-ray, d; day, h; hour, ETT; endotracheal tube, GI; gastrointestinal, HIV; human immunodeficiency virus, L; left, LLL; left lower lobe, m; month, NSAID; non-steroidal anti-inflammatory drug, Pv; Plasmodium vivax, R; right, RLL; right lower lobe, RML; right middle lobe, RUL; right upper lobe, y; year. To comply with the BMC policy on patient confidentiality, details on gender were removed from the table to ensure there were less than three indirect identifiers per patient.