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This is the first systematic review and meta-analysis demonstrating the global prevalence and mortality of severe <jats:italic>P. malariae<\/jats:italic> infection in humans.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All research articles published on the severity and mortality of <jats:italic>P. malariae<\/jats:italic> infection cases in humans were retrieved from three public databases: PubMed, Scopus, and ISI Web of Science. The pooled prevalence estimate and 95% confidence interval (CI) of complications in patients with <jats:italic>P. malariae<\/jats:italic> malaria was analysed using the random-effects model provided in Stata software. The pooled odds ratio (OR) and 95% CI of severe malaria for <jats:italic>P. malariae<\/jats:italic> infection and <jats:italic>Plasmodium falciparum<\/jats:italic> infection were analysed using Review Manager software.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Six studies were used to estimate the pooled prevalence of severe <jats:italic>P. malariae<\/jats:italic> malaria. Out of 10,520 patients infected with <jats:italic>P. malariae<\/jats:italic>, the pooled prevalence estimate of severe <jats:italic>P. malariae<\/jats:italic> infection was 3% (95% CI 2\u20135%), with high heterogeneity (I<jats:sup>2<\/jats:sup>: 90.7%). Severe anaemia (3.32%), pulmonary complications (0.46%), and renal impairments (0.24%) were the most common severe complications found in patients with <jats:italic>P. malariae<\/jats:italic> infection. The pooled proportion of severe anaemia for <jats:italic>P. malariae<\/jats:italic> infection and <jats:italic>P. falciparum<\/jats:italic> infection was comparable among the four included studies (OR: 0.74, 95% CI 0.22\u20132.45, I<jats:sup>2<\/jats:sup>\u2009=\u200998%). The pooled proportion of pulmonary complications was comparable between patients with <jats:italic>P. malariae<\/jats:italic> infection and those with <jats:italic>P. falciparum<\/jats:italic> infection among the four included studies (OR: 1.44; 95% CI 0.17\u201312.31, I<jats:sup>2<\/jats:sup>: 92%). For renal complications, the funnel plot showed that the pooled proportion of renal complications for <jats:italic>P. malariae<\/jats:italic> infection and <jats:italic>P. falciparum<\/jats:italic> infection was comparable among the four included studies (OR: 0.94, 95% CI 0.18\u20134.93, I<jats:sup>2<\/jats:sup>: 91%). The mortality rate of patients with <jats:italic>P. malariae<\/jats:italic> infection was 0.17% (18\/10,502 cases).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This systematic review demonstrated that approximately two percent of patients with <jats:italic>P. malariae<\/jats:italic> infection developed severe complications, with a low mortality rate. Severe anaemia, pulmonary involvement, and renal impairment were the most common complications found in patients with <jats:italic>P. malariae<\/jats:italic> infection. Although a low prevalence and low mortality of <jats:italic>P. malariae<\/jats:italic> infection have been reported, patients with <jats:italic>P. malariae<\/jats:italic> infection need to be investigated for severe anaemia and, if present, treated aggressively to prevent anaemia-related death.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12936-020-03344-z","type":"journal-article","created":{"date-parts":[[2020,7,31]],"date-time":"2020-07-31T12:03:58Z","timestamp":1596197038000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":60,"title":["Global prevalence and mortality of severe Plasmodium malariae infection: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"19","author":[{"given":"Manas","family":"Kotepui","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwuntida Uthaisar","family":"Kotepui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni D.","family":"Milanez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick R.","family":"Masangkay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,31]]},"reference":[{"key":"3344_CR1","unstructured":"WHO. 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