Complicated malaria affects heart of children —Expert

Many people assume malaria to be that “common disease”. In this report by SADE OGUNTOLA, experts say if left untreated promptly and appropriately, it may also be dangerous for the heart in young children

M ALARIA can cause a range of symptoms and life-threatening complications, so an early and accurate diagnosis is crucial. Now, experts suggest that malaria infection is linked to 30 per cent higher risk of heart failure.

The researchers had used Danish nationwide registries to identify patients with a history of malaria infection between January 1994 and January 2017. The average age of patients in the study was 34 years old and 58 per cent were male.

According to World Health Organisation (WHO), malaria affects more than 219 million people worldwide, each year. It is caused by a parasite that takes time to establish itself in the body before symptoms appear. Initial symptoms of malaria usually begin a few days to several weeks after exposure to the parasite, but they can also appear up to a year later.

Malaria is classified as either uncomplicated or severe. Severe or complicated malaria is a medical emergency that requires aggressive treatment. In most cases, malaria can be cured if it’s diagnosed and treated quickly according to established medical guidelines.

Severe malaria is one that has life-threatening complications. This may include the swelling of the blood vessels of the brain, or cerebral malaria; an accumulation of fluid in the lungs that causes breathing problems or pulmonary oedema.

Organ failure of the kidneys,  liver, or spleen; anaemia due to the destruction of red blood cells, jaundice and low blood sugar can occur.

Also, cerebral malaria, which can cause the brain to swell, can sometimes lead to permanent brain damage. It can also cause fits (seizures) or loss of consciousness.

A total of 3,989 malaria cases were identified, with 40 per cent having plasmodium falciparum, the parasite transmitted through mosquito bites that is responsible for the majority of severe malaria cases in humans.

The 11-year follow-up of patients found 69 cases of heart failure, which was very high as compared to the general population, and 68 cases of cardiovascular death, which was considered within a normal range.

The study was presented at the ESC Congress 2019 together with the World Congress of Cardiology revealed as many as 69 cases of heart failure, which was very high as compared to the general population, and 68 cases of cardiovascular death, which was considered within normal range.

The researchers in a release said “We have seen an increase in the incidence of malaria cases and what is intriguing is we have seen the same increase in cardiovascular disease in the same regions.”

Although the authors didn’t identify any link between malaria and heart attack or cardiovascular death, they said the relationship between malaria infection and heart failure was notable.

However, although the study is still in its infancy, they suggested that the findings could be a therapeutic target for the control and prevention of cardiovascular diseases in malaria-endemic areas.

Dr Okechukwu Ogah, a consultant physician and cardiologist at the University College Hospital (UCH), Ibadan, however, stated that “malaria will not make an adult to go into heart failure but children are at a high risk of anaemia and it this anemia that could lead to heart failure. So that makes the possibility of this occurring in children higher than in adults.”

Dr Babatunde Ogunbosi, a consultant pediatrician, University College Hospital said uncomplicated malaria as a disease cannot cause heart failure in children.

Nonetheless, he added that severe anaemia in a child with malaria can predispose the child to developing a heart failure.

“There are things in malaria that can make a child have heart failure, take for example, if a patient has severe anaemia as a result of malaria, they can have heart failure.

“If they have a kidney failure from severe anaemia, heart failure can also follow. Of course, there are malaria complications that can be associated with heart failure, but simple or uncomplicated malaria in itself cannot increase the risk of heart failure. I am not sure there is any evidence for that.”

Dr Ogunbosi, however, declared malaria as a disease that parents should not overlook but get treated early and properly in children.

“It is one of the big contributors to deaths in children under five years of age despite the facts suggesting that deaths from it in Nigeria have reduced significantly in the recent years,” he added.

Sadly, severe malaria is still a problem in Nigeria. According to Dr Ogunbosi, “Nigeria is one of the biggest contributors to severe forms of malaria; it contributes like a quarter of global burden of severe malaria.”

He declared that malaria only become severe when it is not detected and treated with appropriate medicines and on time.

“Rather than treating complications, more attention must be paid to addressing risk factors that predispose to malaria such as environmental and individual factors. Of course very important is prompt diagnosis, treatment and follow up,” he declared.

No doubt, infection with malaria parasites may result in a wide variety of symptoms, ranging from absent or very mild symptoms to severe disease and even death.  Unfortunately, Dr Ogunbosi warned that illnesses in children can progress rather fast, especially when they are febrile in nature like malaria.

“So if a child has fever, don’t just give paracetamol and wait two to three days before consulting the doctor. That teaching I have advocated against over the years; it is wrong.

“Most children that die from severe malaria will die within the first 24 to 48 hours. So a child that has a fever should get evaluated and treated if it is malaria, especially such is less than five years.”

Even though mothers are encouraged to give a child suspected to have malaria medication the first dose of antimalarial if there is no immediate access to health care, he added, “it is important that the child be taken to the hospital immediately or as soon as possible.”

Dr Ogunbosin said this is very important to ensure that the child could be tested to be sure to actually have malaria, treated with the appropriate drug and then tracked afterwards.

“If you test and it is not malaria, then the child does not have to complete the antimalaria dose but look for the cause of the fever. You track the patient because we live in a malaria-endemic area and all of us carry malaria parasite in our blood system.

“So, the fact that you have tested a patient for malaria, the patient has a fever does not mean that it is only malaria. There may be other things. That is why we need to track them. Patients can develop complications when they have started treatment and also there might be other things causing the fever aside from malaria.”

While more researches will be needed to further authenticate the findings, recent studies have suggested that malaria could be a contributor to functional and structural changes in the myocardium, which is the muscle tissue of the heart.

Experimental studies have also shown that malaria may affect the blood pressure regulatory system causing hypertension, which is a contributor to heart failure.

Malaria can also, affect blood flow pathway thereby causing inflammation in the heart which could lead to fibrosis and then heart failure.

But the European Society of Cardiology (ESC) said a combination of high blood pressure, diabetes, obesity, and coronary artery disease are among the most common risk factors for heart failure.

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