Malaria in a tertiary health care facility of Central India with special reference to severe vivax: implications for malaria control

Abstract

Plasmodium vivax is now recognized as a cause of severe and fatal infection in many parts of the world. This prospective observational study was undertaken in a tertiary health setting to understand the spectrum of the disease burden and associated complications due to P. vivax malaria in central India. A malaria clinic under Regional Medical Research Centre for Tribals is operational at Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur in central India, where all fever cases and cases with history of fever were referred for screening of malaria parasite by microscopy and rapid diagnostic test kits. Confirmation of all the cases was done by PCR targeting 18s ribosomal RNA gene of the parasite to exclude mixed infection with P. falciparum. Severe vivax malaria was found in 22 (11·1%) out of 198 vivax patients. Cerebral malaria, seizures, severe malaria anaemia, and respiratory distress each were observed in 32% subjects. Multi-organ dysfunction syndrome was common (36%). Mortality was recorded in two patients and neurological sequelae were also observed in two patients at the time of discharge. This is the first report from Central India where P. vivax has been shown to be associated with severe signs of malaria. Severe vivax malaria is a relatively new clinical entity and further studies from different parts of the world are needed to understand clinical spectrum and burden of P. vivax not only for successful treatment, but also for designing and developing effective malaria control measures.

Demographic and clinical profiles of Plasmodium falciparum and Plasmodium vivax patients at a tertiary care centre in southwestern India

“…Lactate, hypoglycaemia, and metabolic acidosis, all of which are important indicators of severe malaria, were not routinely measured due to existing hospital practices. Malaria patients admitted to the GMC who required use of a ventilator, presumably due to respiratory distress [29, 47], which also has been commonly reported in severe P. vivax, were not included in the present study. This may impact the disease burden being reported among P. vivax and/or P. falciparum cases.…”

“…In contrast to Africa, malaria transmission in India is more limited, both adolescents and adults are at risk of severe malaria, and a substantial proportion of cases are infected with P. vivax rather than the traditionally more virulent P. falciparum . Although many expansive and comprehensive studies have been carried out in Africa [9–14] and Southeast Asia [15–20] to examine pathogenesis and mortality determinants in malaria-positive patients, a more limited number of such studies, generally smaller in scope, have been conducted within India [21–29]. …”

Heterogeneous genetic diversity pattern in Plasmodium vivax genes encoding merozoite surface proteins (MSP) -7E, −7F and -7L

“…Malaria remains a major public health problem worldwide. Plasmodium falciparum is the parasite species causing the lethal form of the disease whilst Plasmodium vivax has long been considered a parasite causing mild disease, thereby diverting attention away from this species regarding research; however, recent studies have reported that this species also causes severe clinical syndromes [ 1 , 2 ]. Even though both species infect humans, they both emerged from different evolutionary lineages; whilst P. vivax shares a common ancestor with Asian non-human primate malaria, P. falciparum has diverged from parasites infecting great apes [ 3 ].…”

Parasitic Infections in Pediatric Population of India: Epidemiology, Diagnosis, and Strategies for Prevention

“…69 Previously, it was thought that falciparum malaria is more dangerous; however, some recent studies have broken the myth and have shown that even vivax malaria is associated with various complications in children. [76][77][78] Rarely, malaria can also present with acute demyelinating encephalomyelitis in young children. 79,80 Microscopic examination of peripheral blood smear remains the gold standard for diagnosis.…”