Risk Factors and Characterization of Plasmodium Vivax-Associated Admissions to Pediatric Intensive Care Units in the Brazilian Amazon

Abstract

Background Plasmodium vivax is responsible for a significant proportion of malaria cases worldwide and is increasingly reported as a cause of severe disease. The objective of this study was to characterize severe vivax disease among children hospitalized in intensive care units (ICUs) in the Western Brazilian Amazon, and to identify risk factors associated with disease severity.Methods and FindingsIn this retrospective study, clinical records of 34 children, 0–14 years of age hospitalized in the 11 public pediatric and neonatal ICUs of the Manaus area, were reviewed. P. falciparum monoinfection or P. falciparum/P. vivax mixed infection was diagnosed by microscopy in 10 cases, while P. vivax monoinfection was confirmed in the remaining 24 cases. Two of the 24 patients with P. vivax monoinfection died. Respiratory distress, shock and severe anemia were the most frequent complications associated with P. vivax infection. Ninety-one children hospitalized with P. vivax monoinfections but not requiring ICU were consecutively recruited in a tertiary care hospital for infectious diseases to serve as a reference population (comparators). Male sex (p = 0.039), age less than five years (p = 0.028), parasitemia greater than 500/mm3 (p = 0.018), and the presence of any acute (p = 0.023) or chronic (p = 0.017) co-morbidity were independently associated with ICU admission. At least one of the WHO severity criteria for malaria (formerly validated for P. falciparum) was present in 23/24 (95.8%) of the patients admitted to the ICU and in 17/91 (18.7%) of controls, making these criteria a good predictor of ICU admission (p = 0.001). The only investigated criterion not associated with ICU admission was hyperbilirubinemia (p = 0.513)].ConclusionsOur study points to the importance of P. vivax-associated severe disease in children, causing 72.5% of the malaria admissions to pediatric ICUs. WHO severity criteria demonstrated good sensitivity in predicting severe P. vivax infection in this small case series.

Clinical Profile of Concurrent Dengue Fever and Plasmodium vivax Malaria in the Brazilian Amazon: Case Series of 11 Hospitalized Patients

“…24 Even without the proper design to estimate if co-infection is associated with more severe complications, this case series describes a high frequency of persistent vomiting, abdominal pain, and bleeding, which are well-known warning signs for severe dengue. 25 Severity criteria for vivax malaria seem to be the same as those originally used for P. falciparum, as shown elsewhere, 26 and were also common in this case series. Respiratory distress is an increasingly reported complication in vivax malaria, 27 and acute lung edema and pleural effusion are common clinical features of severe dengue.…”

Evidence and Implications of Mortality Associated with Acute Plasmodium vivax Malaria

“…It is a seminal contribution pro- viding key evidence pointing to fatal vivax malaria as not only plausible but also confirmed in these patients. Table 6 lists evidence gathered from retrospective hospital-based studies (120)(121)(122)(123)(124)(125)(126)(127)(128)(129). The authors of these reports typically surveyed records of admission to hospitals with a primary diagnosis of malaria.…”

Malaria cases in Switzerland from 2005 to 2015 and recent rise of imported Plasmodium vivax malaria

“…In a study in a Brazilian hospital, the criteria for severe P. falciparum malaria correlated well with a diagnosis of P. vivax and admission to an intensive care unit (ICU), although the parasite densities associated with ICU admission were relatively low (500 parasites/μL blood) (60). Reported manifestations of severe P. vivax malaria include severe anaemia, thrombocytopenia, acute pulmonary oedema and, less commonly, cerebral malaria, pancytopenia, jaundice, splenic rupture, haemoglobinuria, acute renal failure and shock.…”