Malaria Severity in Mangaluru City in the Southwestern Coastal Region of India

Abstract

Dakshina Kannada district in the Southwestern region of Karnataka state, India, including Mangaluru city is endemic to malaria. About 80% of malaria infections in Mangaluru and its surrounding areas are caused by Plasmodium vivax and the remainder is due to Plasmodium falciparum. Malaria-associated clinical complications significantly occur in this region. Here, we report the pathological conditions of 41 cases of fatal severe malaria, admitted to the district government hospital in Mangaluru city during January 2013 through December 2016. The results of clinical, hematological, and biochemical analyses showed that most of these severe malaria cases were associated with thrombocytopenia, anemia, metabolic acidosis, acute respiratory distress, and single or multi-organ dysfunction involving liver, kidney, and brain. Of the 41 fatal malaria cases, 24, 10, and seven patients had P. vivax, P. falciparum, and P. vivax and P. falciparum mixed infections, respectively. These data suggest that besides P. falciparum that is known to extensively cause severe and fatal malaria illnesses, P. vivax causes fatal illnesses substantially in this region, an observation that is consistent with recent findings in other regions.

Decreasing trend of imported malaria cases but increasing influx of mixed P. falciparum and P. vivax infections in malaria-free Kuwait

“…Consistent with our findings, several recent studies from India which had employed molecular (PCR) methods for detection of malaria cases had also reported mixed P. falciparum/P. vivax infections in 11% to 45% of patient samples [27,28]. Some studies have also concluded that since field diagnosis of malaria at the primary health care level in India is mostly performed by microscopy which has low sensitivity/accuracy in diagnosing multiple species malaria, cases of mixed species infection are usually missed [27,[29][30][31].…”

“…vivax infections in 11% to 45% of patient samples [27,28]. Some studies have also concluded that since field diagnosis of malaria at the primary health care level in India is mostly performed by microscopy which has low sensitivity/accuracy in diagnosing multiple species malaria, cases of mixed species infection are usually missed [27,[29][30][31]. This is also evident from the fact that~17% of mixed infections were initially identified as monoinfections due to P. falciparum in one study from India [29].…”

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“…The study also emphasized that microscopy and rapid diagnostic tests had lower sensitivity than PCR, resulting in underdiagnosed malaria in the rural regions of India [ 81 ]. In southwestern regions of India, P. vivax infections account for approximately 80% of malaria which have been reported to cause severe malaria leading to more deaths than P. falciparum [ 82 ]. In Mangaluru City in southwestern India, a study examined a total of 579 malaria patients and reported that 364 (62.9%) had P. vivax infection, 150 (25.9%) had P. falciparum while 65 (11.2%) patients had Plasmodium spp.…”

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“…One study carried out in the southwestern regions of India showed that P. vivax infections account for approximately 80% of malaria cases, which have been reported to cause severe malaria, leading to more deaths than P. falciparum infections [ 68 ]. Another recent study carried out in Mangaluru city in southwestern India examined a total of 579 malaria patients and reported that 364 (62.9%) had P. vivax infection, 150 (25.9%) had P. falciparum infection while 65 (11.2%) patients had mixed infection by two Plasmodium species [ 69 ]. The study also reported that the majority (506 or 87%) of malaria patients had mild malaria, which may be attributed to prompt treatment with antimalarial drugs or previous exposure to the malarial parasite.…”

“…Several studies have shown that mixed Plasmodium spp. infections are reported frequently from India [ 66 , 69 , 70 , 71 ]. Data from more recent studies have shown that P. falciparum , which had dominated India’s malaria cases previously, is now showing a decreasing trend over the past few years, from 65.4% in 2017 to 46.4% in 2019.…”