Gresnigt, T. M. (2012) Non-invasive measurement of methemoglobin (MetHb) as marker of disease severity in children with malaria. thesis, Medicine.
Full text available on request.Abstract
Study Site: Medical Research Unit, Albert-Schweitzer Hospital, Lambaréné, B.P. 118, Gabon Background: Malaria infection interferes with hemoglobin by disruption of red blood cells and by conversion of hemoglobin to methemoglobin (MetHb). Methemoglobin is the oxidized form of hemoglobin, which does not bind oxygen. Based on a murine model of a previous study, it is expected that in case of cerebral malaria, hemoglobin is oxidized to MetHb which then releases the highly inflammatory heme, which in turn triggers the release of cytokines and other mediators and contributes to the picture of ‘cerebral malaria’. The aim of this study is to establish a correlation between MetHb levels and differences in the severity of malaria, and whether MetHb could therefore be a marker for disease severity in malaria patients. Patients, Material and Methods: Children aged 12 to 120 months were recruited at the Medical Research Unit of the Albert Schweitzer Hospital (MRU-HAS) in Lambaréné/Gabon, as well as at the outpatient clinic of the paediatric ward of the HAS and a research outpost in Fougamou. For the control group, healthy volunteers were recruited at the kindergarten of the HAS; children with other diseases were recruited at the outpatient clinic of the paediatric ward. This cross-sectional study comprises three groups, consisting of a control group and two groups of patients with malaria, subdivided into uncomplicated malaria and severe malaria, which is defined as severe anemia (Hb < 6 g/dl) or cerebral malaria (BCS<4). MetHb levels were non-invasively determined on presentation using a Masimo® Rad-57 Pulse oximeter. Results: 103 children with malaria were measured, of which 14 had severe disease (13,6%); 9 severe anemia (8,7%) and 5 cerebral malaria (4,9%). 88 controls were measured. MetHb levels of children with malaria, non severe (1,8 ± 0,3) and severe (2,1 ± 0,7) are demonstrated to be significantly elevated compared to controls (1,6 ± 0,3). We did not demonstrate a significant correlation between parasitemia and MetHb values, nor between Hb and MetHb values. Conclusion: In conclusion, this study has demonstrated that, although small in number, the MetHb level is significantly elevated in severe cases, and cerebral malaria cases in particular compared to a control group and an uncomplicated malaria group. To elucidate the value of MetHb as a potential (prognostic) marker of disease severity and hence the value of routine measurement of MetHb in children with malaria, further research is warranted.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | UMCG supervisor: and Rheenen Dr. P.F. van and Paediatric Gastroenterologist, University Medical Center Gro |
| Supervisor name: | Supervisor: and Grobusch, Prof. Dr. M. P. and Center of Tropical Medicine and Travel Medicine, Department and Institute of Tropical Medicine, University of Tuebingen and Medical Research Unit, Albert Schweitzer Hospital and Co-Supervisor: and Hänscheid, Prof. Thomas and Institute of Molecular Medicine, University of Lisbon |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:58 |
| Last Modified: | 25 Jun 2020 10:58 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1861 |
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