Mortality attributable to Plasmodium vivax malaria: a clinical audit from Papua, Indonesia

Abstract

Background: Plasmodium vivax causes almost half of all malaria cases in Asia and is recognised as a significant cause of morbidity. In recent years it has been associated with severe and fatal disease. The extent to which P. vivax contributes to death is not known. Methods: To define the epidemiology of mortality attributable to vivax malaria in southern Papua, Indonesia, a retrospective clinical records-based audit was conducted of all deaths in patients with vivax malaria at a tertiary referral hospital. Results: Between January 2004 and September 2009, hospital surveillance identified 3,495 inpatients with P. vivax monoinfection and 65 (1.9%) patients who subsequently died. Charts for 54 of these 65 patients could be reviewed, 40 (74%) of whom had pure P. vivax infections on cross-checking. Using pre-defined conservative criteria, vivax malaria was the primary cause of death in 6 cases, a major contributor in 17 cases and a minor contributor in a further 13 cases. Extreme anaemia was the most common primary cause of death. Malnutrition, sepsis with respiratory and gastrointestinal manifestations, and chronic diseases were the commonest attributed causes of death for patients in the latter two categories. There were an estimated 293,763 cases of pure P. vivax infection in the community during the study period giving an overall minimum case fatality of 0.12 per 1,000 infections. The corresponding case fatality in hospitalised patients was 10.3 per 1,000 infections. Conclusions: Although uncommonly directly fatal, vivax malaria is an important indirect cause of death in southern Papua in patients with malnutrition, sepsis syndrome and chronic diseases, including HIV infection.

Fixed-Dose Artesunate–Amodiaquine Combination vs Chloroquine for Treatment of Uncomplicated Blood Stage P. vivax Infection in the Brazilian Amazon: An Open-Label Randomized, Controlled Trial

“…Plasmodium vivax is the malaria-causing parasite species with the widest geographical distribution, resulting in 2.85 billion people at risk [2]. Studies from all P. vivax endemic areas demonstrate that this infection can progress to have severe and fatal outcomes [3, 4], rendering the long-held belief that P. vivax is benign as no longer valid [5]. …”

Role of Plasmodium vivax Duffy-binding protein 1 in invasion of Duffy-null Africans

“…P. vivax is not yet adapted to Duffy-null Africans in that it now causes a less severe infection than in Duffy-positive people (14,20). The concern is that P. vivax may adapt to infection in Duffy-blood-group-null Africans such that it may become a new cause of severe disease (42)(43)(44). (22)] was synthesized and cloned into the pRE4 vector (kind gift from Gary Cohen and Roselyn Eisenberg, School of Dental Medicine, University of Pennsylvania, Philadelphia) in unique ApaI and PvuII restriction enzyme sites.…”

Global Epidemiology of Plasmodium vivax

“…The risk of a P. vivax infection presenting severe symptoms is difficult to quantify because of the inherent difficulty in estimating the number of P. vivax infections in a community (the denominator of this risk estimate). Recent studies aiming to quantify rates of severe disease and fatality used varying metrics to represent “total P. vivax cases,” including hospital cases,20 community surveyed infections,155 and regional case notifications 19,156. The discrepancies in the number of cases captured through community surveys and those reporting to hospital make comparing rates of severe disease and death between studies difficult.…”

“…Malnutrition is also an important predisposing factor for severe outcomes of P. vivax infection and is commonly diagnosed in severe vivax malaria patients globally 13,16,155,171. Given the high prevalence of malnutrition across malaria-endemic zones, further studies are needed to better establish the risks of P. vivax disease associated with malnutrition, and the programmatic possibilities for interventions addressing these simultaneously.…”