Imported malaria : improving assessment of severity and complications

The aim of this thesis is to answer several questions raised while caring for patients with imported malaria in Rotterdam.

The challenge in the care for patients with imported malaria lies in the fact that most hospitals in non-endemic countries have little experience in diagnosing and treating the infection and in recognizing patients at risk for a severe course of the infection. Therefore, in the first part of this thesis, we question which parameters could help to improve the identification of patients at risk for a severe infection. In the first chapters, we focus on the novel host parameters triggering receptor expressed on myeloid cells 1 (TREM-1), neopterin and procalcitonin and copeptin. Next we explore the dynamics of leukocyte count changes in detail in a Controlled Human Malaria Infection trial and we investigate whether the routinely measured differential leukocyte count can be used to predict a severe course of the disease. In the last two chapters we focus on parasite-derived parameters that can be obtained from routinely performed malaria rapid tests or blood slides.

In the second part we aim to gain insight in two morbidities frequently encountered in the clinical practice of imported malaria. We study the frequency of the occurrence of acute kidney injury (AKI) in imported malaria and describe a pilot study that examines whether the novel marker Neutrophil Gelatinase-Associated Lipocalin (NGAL) could help to early identify malaria patients at risk for AKI. Hereafter we question how commonly hyponatraemia occurs in imported malaria and whether there is an association with severity of the disease and we aim to gain insight in its pathophysiology.