Muscle cell injury, haemolysis and dark urine in children with falciparum malaria in Papua New Guinea

Transactions of the Royal Society of Tropical Medicine and Hygiene
A O'DonnellS J Allen

Abstract

During a prospective study of red cell variants and severe malaria in children, a surprising observation was the occurrence of dark urine. Children were grouped according to urine findings: 22 had dark urine that contained a haem protein (Group I), 93 had urine of normal colour that contained a haem protein (Group II) and 236 had normal urine (Group III). To investigate the cause of dark urine, haemolysis and muscle cell injury were assessed. Intravascular haemolysis was greater in Group I than in Groups II and III. However, anaemia was more severe in Group III and is likely to have resulted mainly from extravascular haemolysis. Median plasma myoglobin concentrations were greater in Groups I and II than Group III (P = 0.00060). Plasma myoglobin was greater in children with cerebral malaria, hyperlactataemia and those who died but was not associated with acidosis. Urine myoglobin was greater in Group I than Groups II and III (P = 0.00054). It is likely that both haemoglobin and myoglobin contributed to dark urine. The association between muscle cell injury and coma suggests sequestration of parasitized red cells as a common underlying pathology. In malaria, hyperlactataemia may result directly from breakdown of muscle protein as...Continue Reading

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Citations

Dec 19, 2007·Malaria Journal·Gideon K HelegbeBartholomew D Akanmori
Oct 9, 2012·Malaria Journal·Wasiu A AjetunmobiDelmiro Fernandez-Reyes
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Nov 23, 2018·BMC Veterinary Research·Heiko SteinLukas Schwarz
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Jun 21, 2017·Journal of Tropical Medicine·Alberto Tobón-CastañoCecilia Giraldo Castro

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