Clinico-laboratory profile of severe Plasmodium vivax malaria in a tertiary care centre in Kolkata

Abstract

Background:Vivax malaria is the most widely distributed human malaria and is responsible for up to 400 million infections every year. Recently, it has become evident that Plasmodium vivax monoinfection could also result in multiple organ dysfunction and severe life-threatening disease as seen in Plasmodium falciparum infection.Materials and Methods:The aim of this study was to note the different clinical and biochemical profiles of adult patients with the severe vivax malaria with regards to complications and outcome. This was a prospective observational study carried out at a tertiary care hospital in Kolkata over 9 month's period. Detailed history and examination findings were noted in all patients. Their clinical presentations, complications, course in ward until discharge or death was noted.Results:A total of 900 cases of vivax malaria were included in the study. Severe disease was present in 200 (22.2%) cases of malaria. There were 108 (54%) patients with single complication (SC) and 92 (46%) patients with the multiple complications (MC). Patients with SC had jaundice (48.1%) followed by cerebral involvement (25.9%), renal failure (7.4%), and pulmonary involvement (3.7%). The MC was found in various combinations and the majority (47.8%) had constellation of two different complications. The mortality rate of patients with the SC and MC was 7.4% and 34.8%. The overall mortality observed in severe vivax malaria was 20% (40/200).Conclusions:In recent years, the clinical pattern of vivax malaria has changed. Severe vivax malaria is now very common with increasing mortality. Not only the number, but also the type of complication influences the outcome of complicated malaria.

Severity in Plasmodium vivax malaria claiming global vigilance and exploration – a tertiary care centre-based cohort study

“…Also, the popular notion of vivax malaria having only ‘benign’ course of infection has been belied [1, 3–7, 11]. Present study aimed to determine the spectrum of severity and its relative contrast between P. vivax and P. falciparum .…”

“…Nadkar et al [6] have described up to four organs involved in both P. vivax and P. falciparum . Sarkar et al [7] have reported up to eight complications and their four combinations with P. vivax . Mohapatra et al [10] have described up to four complications in both P. falciparum and mixed infections whereas as Tjitra et al [11] have explained only three complications and their combinations across P. vivax, P. falciparum and mixed infection.…”

“…Plasmodium falciparum is entrenched to be associated with life-threatening complications, leading to widespread global annual mortality. There has been a gradual increase in reports describing sporadic atypical manifestations [1–4] to wide spectrum severity [5–7] among Plasmodium vivax patients from India and other parts of the globe. Of late this clamour on the rising severity in P. vivax malaria has raised concerns among the scientific community.…”

“…In India, there have been few investigations to determine the spectrum of severity and its associated factors with P. vivax in comparison to P. falciparum . In the existing literature from India and elsewhere, studies have been either case reports [1–3], or have lacked a denominator or comparison with other malaria species [7] or multivariate logistic regression analysis [6, 7, 10], or have described exiguous complications [11]. …”

Imported Plasmodium vivax malaria with severe thrombocytopaenia: can it be severe malaria or not?

“…Information regarding the relationship between vivax malaria and thrombocytopaenia adopted as a criterion for assessing malaria severity may be also extracted from 17 clinical studies (13 from India [ 13 , 14 , 52 – 62 ], two from Pakistan [ 63 , 64 ] and one each from Colombia and Sudan [ 65 , 66 ]). In fifteen of these studies, a cut-off value of less than 50,000 platelets per μL was used to define severe thrombocytopaenia [ 13 , 52 – 60 , 62 – 66 ]. Overall, platelet counts below 50,000/μL were present in 335 out of the 906 cases of severe malaria examined (36.9 %), although the prevalence varied significantly among the studies, from 12.5 % to 93 % (Table 2 ), because of the different selection criteria employed.…”