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A
prospective study was performed to evaluate thrombocytopenia as a symptom or
a marker of severity in 2 groups of children hospitalized for an acute Plasmodium
falciparum malaria attack., non immune traveler living in Paris and
immune living in Dakar
Group 1 : 81 children
(mean age 7.8 y) living in Paris and hospitalized after a travel in Africa,
with a low to mild severe attack . 50% had <1% parasitised red cells, and
10% had >5%.
Group 2 : 85 children
(mean age : 6.5 y) hospitalized in Dakar (cerebral malaria in 25, severe
attack in 44). 46% had <1% parasitised red cells and 14% had >5%.
A thrombocytopenia
<50,000/mm3 was present in admission in 8.6% of children in Paris and
14.1% in Dakar, all without mucosal bleeding. A platelet count < 150,000
was found in 47% in Paris and 51.8% in Dakar. Platelet counts were
independent of age, anemia, convulsions, occurrence of cerebral malaria or
recovery (3 deaths in Dakar).14/29 (48.2%) children with cerebral malaria had
platelet count <150,000. In Paris, 3 children with very low parasitemia
and platelet count < 50,000 and were referred to hospital as idiopathic
febrile thrombocytopenia.
Thrombocytopenia appears to be
a frequent symptom of Plasmodium falciparum malaria attack in children
, either in immune and non immune populations, but is not a marker of
severity.
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