Table 4.
Severity Criteria on Presentation
| Case | Anemia | AKI | Hypoglycemia | Acidosis | Hyperparasitemia | Jaundice | Comaa | Shock | Bleeding | Respiratory Distress | Total |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A1 | N | Y | NR | NR | Y | Y | N | N | N | N | 3 |
| A2 | N | NR | NR | NR | N | Y | N | N | N | Y | 2 |
| A3 | N | NR | NR | NR | Y | Y | N | N | N | N | 2 |
| A4 | N | Y | NR | NR | Y | Y | N | N | N | N | 3 |
| B1 | N | Y | Y | Y | Y | Y | NR | Y | NR | Y | 7 |
| B2 | N | N | N | N | Y | Y | NR | N | NR | Y | 3 |
| C1 | N | NR | NR | NR | Y | NR | N | Y | N | Y | 3 |
| D1 | N | Y | Y | Y | NR | Y | N | Y | N | Y | 6 |
| D2 | N | Y | N | Y | NR | Y | N | Y | N | Y | 5 |
| D3 | N | Y | Y | Y | NR | Y | N | Y | N | Y | 6 |
| D4 | N | Y | N | N | NR | N | N | N | N | Y | 2 |
| D5 | N | N | N | N | NR | N | N | Y | N | Y | 2 |
| D6 | N | Y | N | N | NR | Y | N | N | N | Y | 3 |
| E1 | N | Y | NR | NR | NR | NR | N | Y | NR | Y | 3 |
| E2 | N | NR | NR | NR | NR | NR | N | N | N | N | 0 |
| E3 | N | Y | NR | Y | NR | Y | N | Y | N | Y | 5 |
| E4 | N | Y | NR | Y | NR | Y | N | N | N | Y | 4 |
| E5 | N | Y | NR | Y | NR | N | N | N | N | Y | 3 |
| E6 | N | NR | NR | Y | N | NR | N | N | N | N | 1 |
| F1 | N | Y | NR | Y | N | Y | N | N | N | N | 3 |
| F2 | N | Y | Y | Y | Y | Y | N | N | N | N | 5 |
| F3 | N | Y | NR | Y | Y | Y | N | N | N | Y | 5 |
| F4 | N | N | NR | Y | N | N | Yb | N | N | Y | 3 |
| F5 | N | N | NR | NR | N | Y | N | N | N | N | 1 |
| F6 | N | N | NR | N | NR | Y | N | Y | N | N | 2 |
| F7 | N | N | NR | NR | Y | NR | N | N | N | N | 1 |
| G1 | N | N | NR | NR | N | NR | N | Y | N | Y | 3 |
| G2 | N | Y | NR | NR | Y | NR | N | N | N | N | 2 |
| G3 | N | Y | NR | Y | NR | N | N | N | N | N | 2 |
| G4 | N | Y | NR | Y | NR | N | N | Y | N | Y | 4 |
| G5 | N | N | Hyper | N | N | N | N | N | N | N | 0 |
| G6 | N | Y | Hyper | Y | Y | Y | N | Y | N | Y | 6 |
| Frequency, No. (%) | 0/32 (0) | 19/27 (70) | 4/11 (36) | 15/21 (71) | 11/18 (61) | 18/25 (72) | 1/30 (3) | 12/32 (38) | 0 (0) | 19/32 (59) |
Definitions of severe Plasmodium knowlesi malaria criteria: severe anemia, hemoglobin <7.0 g/dL (adults) or <5.0 g/dL (children); AKI, creatinine >265 µmol/L; hypoglycemia, blood glucose <2.2 mmol/L; metabolic acidosis, bicarbonate <15 mmol/L or lactate >5 mmol/L; hyperparasitemia, parasite count >100 000 parasites/µL (or >2% infected red blood cells); jaundice, bilirubin >50 µmol/L, with parasitemia >20 000/µL and/or creatinine >132 µmol/L; coma, Glasgow Coma Scale (GCS) <11; shock, systolic blood pressure <80 mm Hg with cool peripheries or impaired capillary refill; significant abnormal bleeding; respiratory distress, oxygen saturation <92% with respiratory rate >30 breaths/minute.
Abbreviations: AKI, acute kidney injury; Hyper, hyperglycemia; N, no; NR, not reported; Y, yes.
aNot reported to date in knowlesi malaria.
bAlternative causes for reduced GCS not excluded.