Plasmodium vivax malaria: related factors to severity in the State of Maranhão, Brazil

Abstract

Introduction: Malaria caused by Plasmodium vivax species has shown signs of severity, recorded with increasing frequency in the medical literature. This study aimed to characterize the signs of severe malaria by Plasmodium vivax in the State of Maranhão, Brazil. Methods: A descriptive cohort study of patients assisted in the field and a historical and concurrent study of a series of cases among hospitalized patients were undertaken to identify the clinical and laboratory signs of severity. Results: A total of 153 patients were included in the study, 13 of whom were hospitalized. Males made up the majority, numbering 103 (67.3%). The age of the patients ranged from 10 to 70 years, 92.2% were natives of the State of Maranhão, and 65% of the patients had had malaria before. The average time elapsed between symptom onset and diagnosis among outpatients was three days, while among hospitalized patients this average reached 15.5 days, a statistically significant difference (p=0.001). The parasitemia ranged from 500 to 10,000 parasites/µl in 92.8% of cases. The clinical and laboratory manifestations of severity were vomiting and diarrhea, jaundice, drowsiness, mental confusion, seizures, loss of consciousness, agitation, bleeding, pale skin, coughing and dyspnea, thrombocytopenia, anemia, elevation of nitrogenous compounds, and elevated transaminases and bilirubin. Conclusions: The monitoring of malaria patients with Plasmodium vivax showed the possibility of aggravation, the intensity of which varied in different circumstances, especially the interval time between falling ill and diagnostic confirmation.

Changes in malaria patterns in Brazil over 28 years (1990-2017): results from the Global Burden of Disease Study 2017

“…One percent of the cases were caused by other species. Noteworthy, P. vivax has been increasingly associated with severe malaria, leading to complications that include respiratory distress, shock, and anemia [59,60,61,62]. In Brazil, the cases of malaria are seldom caused by P. malariae, and those are usually restricted to speci c Amazon regions and its surroundings [58,63].…”

Vivax malaria in an Amazonian child with dilated cardiomyopathy

“…In recent years, it has been shown that this so-called benign malaria can result in severe presentation with multiple organ dysfunction and life-threatening disease. The majority of severe vivax malaria cases have been reported in India [1-4], but many cases occurred in other countries where there is active transmission, such as Ethiopia [5], Sudan [6], Cambodia [7], Colombia [8], and Brazil [9-12]. Criteria for diagnosing severe vivax malaria, as opposed to severe falciparum malaria, are still not clearly defined, since some biological features of these two parasites are different, and in the meantime the WHO definition for severe falciparum malaria is used [13].…”

Malaria epidemiology in the State of Piauí, Northeastern Brazil: a retrospective study with secondary data

“…Although the State of Piauí is situated outside the Amazon, it borders Maranhão and Tocantins, two states located in the Amazonian region. These two states have active transmission of malaria (11) (12) .…”