Plasmodium vivax malaria in children and adolescents - epidemiological, clinical and laboratory features

Abstract

Objective: Evaluation of epidemiological, clinical and laboratory features of Plasmodium vivax malaria in children and adolescents.Methods: This study was carried out in the Malaria Program of the Evandro Chagas Institute (Belém, Pará), from January 1995 to November 1996. 100 children and adolescents with the diagnosis of P. vivax malaria (thick blood film) were randomly enrolled. A protocol was created to assess epidemiological, clinical and laboratory parameters of this pathology.Results: Malaria occurred in both sexes, and had a prevailing incidence among adolescents (37%). Most of the children and adolescents (92%) had been infected in the State of Pará. Autochthonous cases in the metropolitan area of Belém accounted for 34 % of the sample. Primary infection was seen in 80% of the patients. Fever was the major onset clinical symptom (88%). A history of typical febrile paroxysm was recorded in only 25% of the casuistic. In the first day of treatment (D0) fever (97%), chills (91%), pallor (85%), splenomegaly (46%) and hepatomegaly (29%) were some of the clinical features observed. Pallor (clinical signal) was found to be significantly (p=0.0004) associated with anemia (hemoglobin rate). There was a high significant negative correlation (p=0.0001) between delay of diagnosis (mean 12,5 days) and hemoglobin values. Regarding parasitological examination, just children and adolescents with positive results to hookworms were significantly (p=0.0133, p=0.0075) more anemic than those who had a positive parasitological examination to other helminths and/or protozoa species.Conclusions: Malaria affected children and adolescents from both sexes. An emphasis on epidemiological and clinical data is an important tool to the precocious diagnosis of the disease. Delay on diagnosis made anemia worse. ResumoObjetivo: Avaliação dos aspectos epidemiológicos, clínicos e laboratoriais da malária por Plasmodium vivax em crianças e adolescentes.Métodos: No ambulatório do Programa de Malária do Instituto Evandro Chagas (Belém-Pará), no período de janeiro de 1995 a novembro de 1996, foram estudadas de modo aleatório 100 crianças e adolescentes com diagnóstico positivo por gota espessa para malária por P. vivax. Elaborou-se um protocolo para avaliação dos aspectos epidemiológicos, clínicos e laboratoriais dessa patologia.Resultados: Acometimento de ambos os sexos, com predomí-nio entre os adolescentes (37%). As crianças e adolescentes em sua maioria (92%) adquiriram a infecção no Pará. Os casos autóctones, área metropolitana de Belém, representaram 34% da amostra. Primoinfecção ocorreu em 80% dos pacientes. Febre foi a manifestação clínica inicial mais freqüente (88%). Relato de paroxismo febril típico (febre terçã) foi obtido em somente 25% da casuística. No 1º dia de tratamento (D0) febre (97%), calafrio (91%), palidez (85%), esplenomegalia (46%) e hepatomegalia (29%) foram alguns dos sinais e sintomas observados. Houve significância estatística (p=0,0004) na correlação entre palidez (avaliação clínica) e anemia (taxa de hemo...

Similar Cytokine Responses and Degrees of Anemia in Patients withPlasmodium falciparumandPlasmodium vivaxInfections in the Brazilian Amazon Region

“…Severe complications of P. vivax infections have been reported consistently in the past years in South America and in other regions of the globe (35,40,60,61). A study focused on children (0 to 14 years old) infected by P. vivax conducted in Belém, the same locality in which we performed part of this study, showed that the vast majority (82.7%) of the patients were anemic (68). These studies referred to hospitalized patients and/or specific groups such as children and provide no information on the prevalence of such complications in the populations in which they occur.…”

“…Although infections by these two species have been considered to be very different, with quite different biological and pathophysiological characteristics, the leveling factor likely is the early phase of the infection at which patients were enrolled in the study, when they looked for health care soon after the first symptoms appeared. In addition, age must have a strong influence, since we dealt mostly with adults, and previous works in this region and in regions with similar epidemiological characteristics showed that children are unequivocally more vulnerable to malaria complications, whether from P. vivax or P. falciparum infection (19,41,68).…”

Children's Environment in Brazil: From Domestic (Indoor) to Regional Threats

“…The prevalence of dengue in children living in areas in the N Region [141,142], CO Region [145] and SE Region [147] have led to a disruption of routine health services, demanding further efforts towards providing technical training to health professionals working on the frontline of dengue treatment in children's patient care. As for malaria, researches had investigated children and adolescents who live in the N region [151,152]. The lethality was 1.6% and besides the common symptoms of malaria triad (fever, chills and headache) they had among others like pallor, anemia, myalgia, vomiting and some degree of malnourishment [151], and there was a prevalence of malaria among adolescents [152].…”

“…As for malaria, researches had investigated children and adolescents who live in the N region [151,152]. The lethality was 1.6% and besides the common symptoms of malaria triad (fever, chills and headache) they had among others like pallor, anemia, myalgia, vomiting and some degree of malnourishment [151], and there was a prevalence of malaria among adolescents [152].…”

“…In that sense, the subtheme "exposure to other biological agents" showed us the importance of epidemiological studies present in endemic regions in Brazil, where the socioeconomic conditions are worse, or by children activities in the forest around the houses. Studies on pediatric malaria are scarce [177] despite the increasing number of cases in children and adolescents due to malaria urbanization in various cities of the Amazon Region [152].…”