{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:27:28Z","timestamp":1789705648779,"version":"4.0.1"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Deutsche Forschungs Gemeinschaft"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Severe Plasmodium falciparum (P.f.) malaria remains a major health threat for travellers. World Health Organization (WHO) defines criteria for severe malaria, including hyperparasitaemia \u226510% infected red blood cells (iRBCs), as major risk factors for adverse outcome. Additionally, WHO recognizes \u2018uncomplicated hyperparasitaemia\u2019 with 4\u201310% iRBC, a parasite density usually defining severe malaria outside endemic areas. Overall, the role of hyperparasitaemia as an independent risk factor in imported severe malaria is unclear, with most data predating the artemisinin era.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively analysed adult in-patients with hyperparasitaemia (\u22654% iRBC) and\/or severe P.f. malaria according to WHO criteria who received artemisinin-based treatment at two German university hospitals 2013\u20132023, to assess the risk for critical disease with need for organ replacement therapy or vasopressors. Based on multivariable nominal logistic regression, we developed a scoring system to identify patients with critical disease and validated it on an independent cohort.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 168 patients, 33 (20%) developed critical disease, all of whom presented with at least one WHO criterion other than hyperparasitaemia. Of 72 patients with isolated hyperparasitaemia, none developed critical disease. Hyperparasitaemia was no independent risk factor for critical disease in logistic regression (adjusted odds ratio (aOR) 0.85 95%CI 0.23\u20133.12), in contrast to creatinine &amp;gt;3\u00a0mg\/dl (aOR 6.74 95%CI 1.06\u201342.75), oligo-\/anuria (aOR 5.94 95%CI 1.27\u201327.82), lactate \u22655\u00a0mmol\/l (aOR 8.16 95%CI 8.16\u201335.03), confusion (aOR 4.07 95%CI 1.39\u201311.94) and circulatory shock and respiratory failure, which are inherently critical conditions. The risk score identified all 33 patients with and 131\/135 (97.0%) without critical disease (AUC\u2009=\u20090.99; sensitivity: 100%; specificity: 97.0%). In the validation cohort, all eight patients with critical disease and 39\/44 (89%) without were correctly identified.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Isolated hyperparasitaemia was no independent risk factor for critical disease in this patient cohort treated with artemisinins, suggesting that such patients can be managed outside intensive care units.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jtm\/taaf049","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T10:41:54Z","timestamp":1748601714000},"source":"Crossref","is-referenced-by-count":5,"title":["Severe imported <i>Plasmodium falciparum<\/i> malaria with hyperparasitaemia: evaluation of determinants of critical disease in adult returning travellers"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5377-3152","authenticated-orcid":false,"given":"Tilman","family":"Lingscheid","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Critical Care Medicine, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Augustenburger Platz 1, 13353 Berlin , Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6805-7407","authenticated-orcid":false,"given":"Johannes","family":"Jochum","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine , Bernhard-Nocht-Stra\u00dfe 74, 20359 Hamburg , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9148-3663","authenticated-orcid":false,"given":"Pinkus","family":"Tober-Lau","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Critical Care Medicine, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Augustenburger Platz 1, 13353 Berlin , Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Sch\u00f6llgen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Critical Care Medicine, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Augustenburger Platz 1, 13353 Berlin , Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Stegherr","sequence":"additional","affiliation":[{"name":"Institute of Biometry and Clinical Epidemiology, Department for Statistical methods of translation and early clinical trials, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin , 10117 Berlin , Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliane","family":"D\u00f6rfler","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Critical Care Medicine, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Augustenburger Platz 1, 13353 Berlin , Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0841-8255","authenticated-orcid":false,"given":"Henrik","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Aalborg University Hospital , 9220 Aalborg , Aalborg,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Bartoloni","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence , 50139 Florence , Tuscany Region,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine","family":"M\u00f8rch","sequence":"additional","affiliation":[{"name":"National Centre for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital , 5021 Bergen , Bergen,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5868-7760","authenticated-orcid":false,"given":"Emmanuel","family":"Bottieau","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Institute of Tropical Medicine , 2000 Antwerp , Antwerp Province,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frieder","family":"Pf\u00e4fflin","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Critical Care Medicine, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Augustenburger Platz 1, 13353 Berlin , Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leif Erik","family":"Sander","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Critical Care Medicine, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Augustenburger Platz 1, 13353 Berlin , Berlin,","place":["Germany"]},{"name":"German Center for Lung Research, DZL , 35392 Gie\u00dfen, Hessen ,","place":["Germany"]},{"name":"Berlin Institute of Health , 10178 Berlin , Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9797-1692","authenticated-orcid":false,"given":"Thomas","family":"Zoller","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Critical Care Medicine, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health , Augustenburger Platz 1, 13353 Berlin , Berlin,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ramharter","sequence":"additional","affiliation":[{"name":"Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine , Bernhard-Nocht-Stra\u00dfe 74, 20359 Hamburg , Hamburg,","place":["Germany"]},{"name":"Centre de Recherches M\u00e9dicales de Lambar\u00e9n\u00e9 , BP 242 Lambar\u00e9n\u00e9, Moyen Ogoou\u00e9,","place":["Gabon"]},{"name":"German Center for Infection Research (DZIF) Partner Site Hamburg, L\u00fcbeck, Borstel, Riems , 20359 Hamburg, Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3807-473X","authenticated-orcid":false,"given":"Florian","family":"Kurth","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Critical Care Medicine, Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin 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