Clinical and epidemiological characterization of severe Plasmodium vivax malaria in Gujarat, India

Abstract

The mounting evidence supporting the capacity of Plasmodium vivax to cause severe disease has prompted the need for a better characterization of the resulting clinical complications. India is making progress with reducing malaria, but epidemics of severe vivax malaria in Gujarat, one of the main contributors to the vivax malaria burden in the country, have been reported recently and may be the result of a decrease in transmission and immune development. Over a period of one year, we enrolled severe malaria patients admitted at the Civil Hospital in Ahmedabad, the largest city in Gujarat, to investigate the morbidity of severe vivax malaria compared to severe falciparum malaria. Patients were submitted to standard thorough clinical and laboratory investigations and only PCR-confirmed infections were selected for the present study. Severevivax malaria (30 patients) was more frequent than severe falciparum malaria (8 patients) in our setting, and it predominantly affected adults (median age 32 years, interquartile range 22.5 years). This suggests a potential age shift in anti-malarial immunity, likely to result from the recent decrease in transmission across India. The clinical presentation of severe vivax patients was in line with previous reports, with jaundice as the most common complication. Our findings further support the need for epidemiological studies combining clinical characterization of severe vivax malaria and serological evaluation of exposure markers to monitor the impact of elimination programmes.

Harnessing the Potential of miRNAs in Malaria Diagnostic and Prevention

“…Thrombocytopenia is common in malaria ( Lacerda et al., 2011 ; Anvikar et al., 2020 ) and has been associated with SM ( Anvikar et al., 2020 ). The miRNA pair miR-4454/miR-7975 was found associated with low platelet counts ( Santos et al., 2021 ).…”

“…Severe falciparum malaria is characterized by multi-organ dysfunctions, which are triggered by the sequestration of infected erythrocytes (iEs) within the microvasculature of the host, combined with an exaggerated production of inflammatory mediators ( White et al., 2013 ; Milner et al., 2014 ). In contrast, Pv infection has been perceived as relatively benign until recently, despite documented debilitating and potentially life-threatening complications ( Gupta et al., 2015a ; Gupta et al., 2016a ; Anvikar et al., 2020 ). Severe malaria (SM) cases have also been reported in patients infected with Pk ( Cox-Singh et al., 2010 ), Po ( Kotepui et al., 2020a ), and Pm ( Kotepui et al., 2020b ), although these remain anecdotal.…”

Ethnic Conflict as a Risk Amplifier for Resurgent P. Vivax Malaria in Temperate Zones: A Case Study from the Caucasus Region.

“…While seasonal malaria is rarely fatal, it can produce signi cant population morbidity, especially in agricultural communities or immunologically naive populations (31). P. vivax is also the most globally prevalent form of malaria, with approximately 2.5 billion individuals at risk worldwide (32). There are potentially serious health complications, including anemia, jaundice and immune system dysfunction (33,34).…”

An Optimized Real-Time qPCR Method for the Effective Detection of Human Malaria Infections

“…Severe malaria, predominantly caused by Plasmodium falciparum ( Pf ), can be portrayed as a multi-system disorder with a wide range of clinical features including destruction of red blood cells (RBC) and stroke due to adhesion and sequestration of parasites resulting in anemia and cerebral malaria [ 14 ]. Recent evidences show us the possibility of severe malaria by Plasmodium vivax ( Pv ) as well which is alarming if not monitored closely as it can render severe Acute Respiratory Distress Syndrome (ARDS) [ 15 , 16 ]. Thus a mass sero-surveillance with a sensitive diagnostic method is required to reduce such toll of deaths by malaria.…”