Childhood Plasmodium vivax Malaria With Severe Thrombocytopenia and Bleeding Manifestations

Thapa, Rajoo; Biswas, Biswajit; Mallick, Debkrishna; Sardar, Swarup; Modak, Sujoy K.

doi:10.1097/mph.0b013e3181b7eb12

Cited by 16 publications

(15 citation statements)

References 11 publications

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“…45,46 Although variable degrees of reduction in circulating platelet count are consistently reported in the different types of malaria, the earlier observations found that thrombocytopenia is quite rare in P. vivax malaria, but recently it has been reported in P. vivax monoinfection in children from many parts of the world including India. [27][28][29][30][31][32][33][34] In this study thrombocytopenia was found in 61.54% children of severe P. vivax malaria, which are comparable to earlier studies. 44,47 The bleeding manifestations were present only in 10.77% patients and these findings are also consistent with earlier studies.…”

Section: Discussionsupporting

confidence: 89%

“…Population-based studies in Venezuela have also showed a rising trend in deaths associated with P. vivax malaria, particularly in children. 26 There are many case reports on various clinical manifestations of severe P. vivax malaria in children from different parts of the world including India, [27][28][29][30][31][32][33][34][35][36][37] but in most of these studies the diagnosis was made by PBF and/or RDT without molecular diagnostic confirmation (PCR). Thus, there are always chances of species misidentification and missing the mixed infection thereby lacking authenticity.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Features of Children Hospitalized with Malaria—A Study from Bikaner, Northwest India

Kochar¹,

Tanwar²,

Khatri³

et al. 2010

The American Society of Tropical Medicine and Hygiene

133

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Severe Plasmodium vivax malaria in adults has been reported from Bikaner (northwestern India) but the reports on children are scanty. This prospective study was done on 303 admitted children of malaria. The diagnosis was done by peripheral blood smear and rapid diagnostic test. Further confirmation of severe P. vivax monoinfection was done by polymerase chain reaction (PCR). The proportion of P. falciparum, P. vivax, and mixed (P. falciparum and P. vivax) infection was 61.01%, 33.99%, and 4.95%, respectively. Severe disease was present in 49.5% (150/303) children with malaria, with the risk greatest among P. vivax monoinfection (63.1% [65/103]) compared with P. falciparum, either alone (42.7% [79/185]; odds ratio [OR] = 2.3 [95% confidence interval (CI) = 1.40-3.76], P = 0.001) or mixed infections (40% [6/15]; OR = 2.57 [95% CI = 0.88-7.48]). In children < 5 years of age, the proportion of severe malaria attributable to P. vivax rose to 67.4% (31/46) compared with 30.4% (14/46) of P. falciparum (OR = 4.7 [95% CI = 2.6-8.6], P < 0.0001) and 2.2% (1/46) of mixed infection (OR = 92 [95% CI = 24.6-339.9], P < 0.0001). The proportion of patients having severe manifestations, which included severe anemia, thrombocytopenia, cerebral malaria, acute respiratory distress syndrome, hepatic dysfunction, renal dysfunction, abnormal bleeding was significantly high in association with P. vivax monoinfection in 0-5 year age group, while the same was significantly high in association with P. falciparum monoinfection in 5-10 year age group. Similarly P. vivax monoinfection had greatest propensity to cause multiorgan dysfunction in 0-5 year age group (34.1% [17/41], P < 0.0001) in comparison to P. falciparum monoinfection, which had similar propensity in 5-10 year age group (36.8% [35/95], P = 0.039). Plasmodium vivax monoinfection was almost equally serious to cause significant mortality in comparison to P. falciparum (case fatality rate of severe P. vivax was 3.9% versus 3.2% of severe P. falciparum malaria; P = 1.0). This study reaffirms the evidence of severe P. vivax malaria in children in Bikaner.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Clinical Features of Children Hospitalized with Malaria—A Study from Bikaner, Northwest India

Kochar¹,

Tanwar²,

Khatri³

et al. 2010

The American Society of Tropical Medicine and Hygiene

133

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“…In an earlier study from Venezuela, thrombocytopenia had been reported in 58.97% of children of Pv monoinfection (with 24.36% severe thrombocytopenia) [8]. In addition, many isolated case reports of severe thrombocytopenia in children with P. vivax monoinfection have been reported from India [9][10][11][12][13][14][15][16][17][18][19]. Recently, profound thrombocytopenia with platelet count as low as 5000/ml has been reported in an 8-year-old child in the Indian literature with vivax malaria [12].…”

Section: Discussionmentioning

confidence: 97%

“…Although severe thrombocytopenia is commonly reported to be associated with Plasmodium falciparum (Pf ) monoinfection and mixed infection (Pf þ Pv; Plasmodium vivax), its occurrence has also been reported in cases of Pv monoinfection. Regarding pediatric population, there are only a few isolated case reports of severe thrombocytopenia with Pv monoinfection from India [10][11][12][13][14][15][16][17][18][19]. The diagnosis of malaria in all these studies was based on peripheral blood film (PBF) examination and rapid diagnostic test (RDT) in which there are chances of misdiagnosis of species as well as missing the mixed infection.…”

Section: Introductionmentioning

confidence: 99%

Thrombocytopenia in childhood malaria with special reference toP. vivaxmonoinfection: A study from Bikaner (Northwestern India)

et al. 2011

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Thrombocytopenia is commonly seen in Plasmodium vivax malaria, but its prognostic value has not been addressed in children. This prospective study included 676 admitted children of malaria [Plasmodium falciparum (Pf) monoinfection 262, Plasmodium vivax (Pv) monoinfection 380, and mixed (Pf + Pv) infection 34], in which thrombocytopenia (platelet count <150 × 10(3)/mm(3) on admission) was found in 442 (65.38%) children [Pf monoinfection 55.3% (145/262), Pv monoinfection 73.16% (278/380), and mixed infection 55.88% (19/34)]. The association of thrombocytopenia was statistically significant with Pv monoinfection [73.16% (278/380)] in comparison to either Pf monoinfection [55.34% (145/262); odds ratio (OR) = 2.199 (95% confidence interval (CI) 1.577-3.068), p < 0.0001] or mixed infection [55.88% (19/34); OR = 2.152 (95%CI 1.054-4.394), p = 0.032]. In Pv monoinfection, thrombocytopenia was highest in 0-5 years age group and subsequently decreased with advancing age, whereas in Pf monoinfection it was reverse. Severe thrombocytopenia (platelet count <20 × 10(3)/mm(3)) was present in 16.52% (73/442) children [Pv monoinfection 21.58% (60/278) and Pf monoinfection 8.97% (13/145)]. The risk of developing severe thrombocytopenia was also highest in Pv monoinfection [15.79% (60/380)] in comparison to Pf monoinfection [10.59% (13/262); OR = 3.591 (95%CI 1.928-6.690), p < 0.0001]. Bleeding manifestations were associated in 21.27% (94/442) children [Pf monoinfection 9.92% (26/262), Pv monoinfection 16.58% (63/380), and mixed malaria 14.71% (5/34)]. All the children having bleeding manifestations had thrombocytopenia but low platelet counts were not always associated with abnormal bleeding. The association of severe malaria was significantly more among children having Pv monoinfection with platelet counts <20 × 10(3)/mm(3) [OR = 2.569 (95%CI 1.196-5.517), p < 0.014] with specificity of 88.3% and positive predictive value of 85%. Till today, thrombocytopenia is not included in severe malaria criterion described by WHO, but when platelet counts <20 × 103/mm(3), we advocate it to include as one of the severe malaria criteria.

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“…[7][8][9]13,[24][25][26][27][28][29][30][31][32][33][34] Furthermore, our study in a vivax monoendemic setting adds to the only two case series that strictly ruled out P. falciparum coinfection by highly specific techniques (i.e., PCR) and shows that P. vivax alone may, indeed, present with severe manifestations. 13,14 In agreement with these two studies conducted in Brazil and India, respectively, we found that there were four criteria (severe anemia, shock, lung injury, and acute renal failure) ( Table 4) that are commonly present in critical illness with P. vivax, despite our use of few criteria to identify critically ill severe vivax cases.…”

Section: Case Control Analysismentioning

confidence: 90%

Plasmodium vivax Hospitalizations in a Monoendemic Malaria Region: Severe Vivax Malaria?

Quispe

Pozo

Guerrero

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Severe malaria caused by Plasmodium vivax is no longer considered rare. To describe its clinical features, we performed a retrospective case control study in the subregion of Luciano Castillo Colonna, Piura, Peru, an area with nearly exclusive vivax malaria transmission. Severe cases and the subset of critically ill cases were compared with a random set of uncomplicated malaria cases (1:4). Between 2008 and 2009, 6,502 malaria cases were reported, including 106 hospitalized cases, 81 of which fit the World Health Organization definition for severe malaria. Of these 81 individuals, 28 individuals were critically ill (0.4%, 95% confidence interval = 0.2-0.6%) with severe anemia (57%), shock (25%), lung injury (21%), acute renal failure (14%), or cerebral malaria (11%). Two potentially malaria-related deaths occurred. Compared with uncomplicated cases, individuals critically ill were older (38 versus 26 years old, P < 0.001), but similar in other regards. Severe vivax malaria monoinfection with critical illness is more common than previously thought.

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Childhood Plasmodium vivax Malaria With Severe Thrombocytopenia and Bleeding Manifestations

Cited by 16 publications

References 11 publications

Clinical Features of Children Hospitalized with Malaria—A Study from Bikaner, Northwest India

Clinical Features of Children Hospitalized with Malaria—A Study from Bikaner, Northwest India

Thrombocytopenia in childhood malaria with special reference toP. vivaxmonoinfection: A study from Bikaner (Northwestern India)

Plasmodium vivax Hospitalizations in a Monoendemic Malaria Region: Severe Vivax Malaria?

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