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

Abstract

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.

Clinical spectrum and treatment outcome of severe malaria caused byPlasmodium vivaxin 18 children from northern India

“…1 In a large prospective study from Bikaner district of North India, it was found that a proportion of under five children infected with P. vivax had a greater propensity for development of complications including severe anaemia, thrombocytopenia, cerebral malaria, acute respiratory distress syndrome, hepatic dysfunction, renal dysfunction, and abnormal bleeding. 3 Similar observations were generated in another study from Delhi where children with severe malaria infected with P.vivax had more hepatic, renal, respiratory, and bleeding complications with less overall mortality when compared to falciparum malaria. 4 P.vivax is being increasingly recognized as a causative agent of severe malaria from North India.…”

“…Recently, P. vivax is being increasingly recognized as one of the etiological factors for severe malaria in children and adults. [1][2][3][4] The clinical presentation of severe malaria caused by P. falciparum and P. vivax were similar among children from Papau New Guinea except for higher chances of respiratory distress among the latter. 1 In a large prospective study from Bikaner district of North India, it was found that a proportion of under five children infected with P. vivax had a greater propensity for development of complications including severe anaemia, thrombocytopenia, cerebral malaria, acute respiratory distress syndrome, hepatic dysfunction, renal dysfunction, and abnormal bleeding.…”

“…P. vivax is increasingly recognized as an important cause of severe malaria in children with clinical manifestations like cerebral malaria, anaemia, and thrombocytopenia. [1][2][3][4] In a large prospective study from Bikaner district of North India, 150 children admitted with severe malaria were analyzed, and it was observed that P. vivax monoinfection contributed to one third of cases. 3 It was also seen that children under 5 years infected with P. vivax infection had higher risk of developing severe malaria when compared to those infected with P. falciparum [OR 2.3 (1.4-3.76)].…”

Study of Methaemoglobin in Malaria Patients

“…Further female Indians are better clothed than males. Kochar et al [8] in their series on malaria in Rajasthan observed that 50.8 % were males and 49.2 % were females. The mean age of cases was 41.66 years and mean age of controls were 39.86 years with no significant difference.…”

Clinical and laboratory profile of Plasmodium vivax malaria patients hospitalized in Apartadó,

“…De igual modo, Kochar, et al reportaron la anemia grave como el hallazgo más frecuente en 150 niños con malaria grave en India, en 63,1 % por P. vivax y en 42,7 % por P. falciparum (25). La anemia se ha asociado frecuentemente con paludismo y es producida por múltiples mecanismos, que incluyen la destrucción de eritrocitos parasitados y no parasitados, la eritrofagocitosis y la inhibición de la eritropoyesis (26).…”