Study: Elevated uric acid risk factor for poor outcomes in kids with severe malaria

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Malaria patient with mother — *United Nations Development Programme/ Flickr cc*

Researchers from Indiana University (IU) and Makerere University in Uganda suggest that high uric acid concentrations (hyperuricemia) are a risk factor for serious complications, death, or long-term neurodevelopmental problems in children diagnosed as having severe malaria (SM), according to a study published last week in Nature Medicine.

A mosquito-borne disease, malaria is a leading cause of death in African children.

"The emergence of drug resistance against [malaria drug] artemisinin derivatives in East Africa threatens to reverse gains in reducing SM mortality," the authors noted. "Numerous adjunctive therapies for SM have failed to reduce mortality in clinical trials, suggesting the need for a better understanding of mechanisms leading to mortality."

Significantly higher risk of death with hyperuricemia

The team analyzed two groups of 1,213 children, 967 of them with SM and 246 community controls. In total, 25% had hyperuricemia, which leads to a buildup of body waste in the blood. Hyperuricemia was caused mainly by ruptured infected red blood cells and kidney injury.

Hyperuricemia was tied to serious complications (eg, kidney injury, coma, intestinal injury), a higher risk of death during or after hospitalization, and long-term cognitive impairment.

Additional studies are needed to determine whether lowering uric acid in children with severe malaria might reduce hospital deaths, post-discharge deaths and long-term cognitive impairment.

Andrea Conroy, PhD

Relative to survivors, a significantly higher percentage of children who died from malaria had hyperuricemia (36% vs 13% in cohort 1; 81% vs 32% in cohort 2). In cohort 1, children with hyperuricemia were at nearly four times the risk for death after adjustment for age and sex. In cohort 2, those with hyperuricemia had nine times the risk of death as controls.

Blood uric acid (BUA) level and risk of in-hospital death were significantly linked, even among children with levels below the hyperuricemia threshold, suggesting a dose-response relationship between BUA and death.

Children with hyperuricemia had more harmful gut bacteria, which can cross the injured gut lining and cause sepsis. "Additional studies are needed to determine whether lowering uric acid in children with severe malaria might reduce hospital deaths, post-discharge deaths and long-term cognitive impairment," co-senior author Andrea Conroy, PhD, of IU, said in a university news release.

Tests under way in suspected Ebola outbreak in DR Congo

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Lisa Schnirring

As many as 12 suspected Ebola virus cases have been reported in Democratic Republic of the Congo’s (DRC’s) Equateur province, according to a DRC media report in French that was translated and posted yesterday by FluTrackers, an infectious disease news message board.

Also, officials from the World Health Organization (WHO) confirmed to Stat that 12 suspected cases, 8 of them fatal, were recorded in the Boyenge health area. Deaths occurred between January 10 and January 22. The official said samples have been sent to the National Institute of Biomedical Research in Kinshasa.

Equateur’s last outbreak occurred in 2022

If confirmed, the outbreak would mark Equateur’s province’s fourth Ebola outbreak since 2018.

Equateur province is the western part of the DRC, far from where fighting is underway in Goma, the capital of North Kivu province in the east. The province’s last outbreak occurred between April and July of 2022 in Mbandaka, the provincial capital. There were five cases, all fatal. Sequencing suggested the outbreak was triggered by a new spillover event from an animal rather than linked to a previous outbreak.

Among older women, elevated white blood cell count linked to severe long COVID

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Stephanie Soucheray, MA

A new study comparing blood samples from menopausal women pre- and post-COVID shows that those with elevated leukocyte (white blood cell) counts may be at greater risk of experiencing more severe symptoms of long COVID. The study was published yesterday in the journal Menopause.

The study was a secondary analysis of data collected through the Women's Health Initiative and used leukocyte count as a proxy for systemic inflammation. In total, 1,237 women with blood samples available from enrollment (taken in 1993 to 1998, 25 years prior to the pandemic) were surveyed from June 2021 to February 2022 about COVID-19 illnesses and symptoms.

The authors found that white blood cell count was positively associated with severity of post-COVID symptoms, but not associated with overall long-COVID occurrence or long-COVID–related cognitive outcomes.

High-sensitivity C-reactive protein (hsCRP) concentrations, another marker of inflammation, was available for less than 27% of participants and was not associated with any long-COVID symptoms.

Prior inflammation may contribute to long COVID

Though the mechanism is unknown, the authors said heightened inflammation before contracting COVID-19 may contribute to the development of significant post-COVID symptoms.

Several studies have shown that older adults, and in particular women, are at greater risk of developing long COVID.

Post-acute sequelae of severe acute respiratory coronavirus 2 infection significantly affects quality of life, often leading to severe disability. This effect is particularly pronounced in women.

"As the authors highlight, post-acute sequelae of severe acute respiratory coronavirus 2 infection significantly affects quality of life, often leading to severe disability. This effect is particularly pronounced in women, who already experience higher rates of cognitive impairment after menopause," said Monica Christmas, MD, associate medical director for the Menopause Society in a society press release. "By understanding underlying factors, we can better address these challenges and work to mitigate the cascade of symptoms that follow."

Quick takes: Zika in India, Georgia measles case, UK antibiotic classification update

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Lisa Schnirring

The World Health Organization (WHO) today said India in 2024 reported 151 Zika virus cases, mostly from Maharashtra, with other from Gujarat and Karnataka states. No related cases of microcephaly or Guillain-Barre syndrome were reported. The numbers from Maharashtra were the highest since 2021. The number in pregnant women isn’t known. The WHO said though Zika virus isn’t unexpected in Maharashtra state, due to the presence of mosquito vectors, the spike in cases compared to previous years is unusual. India reported its first Zika case in 2016.
The Georgia Department of Public Health yesterday reported the state’s first measles case of 2025, which involves an unvaccinated Atlanta resident who had traveled within the United States. Health officials said they are tracking people who were exposed to the patient while he or she was infectious between January 19 and January 24.
The United Kingdom Health Security Agency (HSA) today updated its antibiotic classification tool, called UK-AWaRe, which helps support antimicrobial stewardship actions. The update was based on a recent review following a similar update from the WHO. In a press release, the HSA said the most significant change was classifying all first-generation cephalosporins as Access, compared to Watch in 2019. It added that the change is designed to give patients with certain allergies wider access to a range of antibiotics that have a lower resistance profile. Unlike the WHO’s update, the HSA tool keeps amoxicillin/clavulanic acid in the Watch category.