Intestinal injury in Ugandan children hospitalized with malaria

Michelle Ngai, Michael T. Hawkes, Clara Erice, Andrea M. Weckman, Julie Wright, Veselina Stefanova, Robert Opoka, Sophie Namasopo, Andrea Conroy, Kevin Kain

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Background: Severe malaria is associated with multiple organ dysfunction syndrome (MODS), which may involve the gastrointestinal tract.

Methods: In a prospective cohort study in Uganda, we measured markers of intestinal injury (intestinal fatty-acid binding protein [I-FABP] and zonula occludens-1 [ZO-1]) and microbial translocation (lipopolysaccharide binding protein [LBP] and soluble complement of differentiation 14 [sCD14]) among children admitted with malaria. We examined their association with biomarkers of inflammation, endothelial activation, clinical signs of hypoperfusion, organ injury, and mortality.

Results: We enrolled 523 children (median age 1.5 years, 46% female, 7.5% mortality). Intestinal FABP was above the normal range (≥400 pg/mL) in 415 of 523 patients (79%). Intestinal FABP correlated with ZO-1 (ρ=0.11, P=.014), sCD14 (ρ=0.12, P= .0046) as well as markers of inflammation and endothelial activation. Higher I-FABP levels were associated with lower systolic blood pressure (ρ= −0.14, P=.0015), delayed capillary refill time (ρ=0.17, P=.00011), higher lactate level (ρ=0.40, P

Conclusions: Intestinal injury occurs commonly in children hospitalized with malaria and is associated with microbial translocation, systemic inflammation, tissue hypoperfusion, MODS, and fatal outcome.

Original languageUndefined/Unknown
JournalPaediatrics and Child Health, East Africa
Publication statusPublished - 1 Dec 2022

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