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This study aimed to explore the prevalence and risk factors related to severe <jats:italic>P. knowlesi<\/jats:italic> infection.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A systematic review was conducted by retrieving all published articles on severe <jats:italic>P. knowlesi<\/jats:italic> available in Web of Science (ISI), Scopus, and PubMed (MEDLINE). Titles, abstracts, and full-text articles were screened, and any irrelevant studies were excluded. The random-effects model was used to compute the pooled prevalence estimate of severe <jats:italic>P. knowlesi<\/jats:italic> infection by a metaprop command provided in STATA software. Differences in demographic characteristics, clinical characteristics, and laboratory data were analysed using Review Manager Version 5.3 software for patients in the following groups: 1) patients with severe and non-severe <jats:italic>P. knowlesi<\/jats:italic> infection and 2) patients with severe <jats:italic>P. knowlesi<\/jats:italic> and severe <jats:italic>P. falciparum<\/jats:italic> infection.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Out of the 2382 studies retrieved from the three databases, seven studies with a total enrolment of 1124 patients with <jats:italic>P. knowlesi<\/jats:italic> infections were eligible to be included in this systematic review and meta-analysis. The pooled prevalence estimate of severe <jats:italic>P. knowlesi<\/jats:italic> infection was 19% (95% <jats:italic>CI:<\/jats:italic> 11\u201327%, <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200993.7%). Severe acute kidney injuries (AKI) (77 cases, 45.6%), jaundice (71 cases, 42%), and hyperparasitaemia (55 cases, 32.5%) were the common clinical manifestations found among patients with severe complications. In comparison to non-severe <jats:italic>P. knowlesi<\/jats:italic> infections, patients with severe <jats:italic>P. knowlesi<\/jats:italic> infections had significantly higher age, leucocyte count, and parasitaemia levels (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). In comparison to patients with severe <jats:italic>P. falciparum<\/jats:italic> infections, patients with severe <jats:italic>P. knowlesi<\/jats:italic> infections had significantly higher age, neutrophil count, and creatinine levels (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This systematic review and meta-analysis demonstrated a high proportion of severe <jats:italic>P. knowlesi<\/jats:italic> infections. Patients with severe <jats:italic>P. knowlesi<\/jats:italic> infections had higher age, leucocyte count, and parasitaemia levels than those with non-severe <jats:italic>P. knowlesi<\/jats:italic> infections. In addition, patients with severe <jats:italic>P. knowlesi<\/jats:italic> infections had higher age, neutrophil count, and creatinine levels than those with severe <jats:italic>P. falciparum<\/jats:italic> infections.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s40249-020-00727-x","type":"journal-article","created":{"date-parts":[[2020,7,29]],"date-time":"2020-07-29T12:02:39Z","timestamp":1596024159000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Prevalence of severe Plasmodium knowlesi infection and risk factors related to severe complications compared with non-severe P. knowlesi and severe P. falciparum malaria: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"9","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":[[2020,7,29]]},"reference":[{"key":"727_CR1","volume-title":"Malaria parasites and other haemosporidia","author":"P Garnham","year":"1966","unstructured":"Garnham P. 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