Severe Plasmodium vivax Malaria: A Report on Serial Cases from Bikaner in Northwestern India

Abstract

Epidemiologic studies and clinical description of severe Plasmodium vivax malaria in adults living in malaria-endemic areas are rare and more attention is needed to understand the dynamics and its interaction with the immune system. This observational study included 1,091 adult patients admitted to medical wards of S. P. Medical College and associated group of hospitals in Bikaner, India from September 2003 through December 2005. The diagnosis of P. vivax malaria was established by peripheral blood film (PBF), rapid diagnostic test (RDT), and polymerase chain reaction (PCR), and severe malaria was categorized as per World Health Organization guidelines. Of 1,091 patients with malaria, 635 had P. falciparum malaria and 456 had P. vivax malaria. Among patients with severe manifestations, 40 had evidence of monoinfection of P. vivax malaria diagnosed by PBF, RDT, and PCR. Complications observed were hepatic dysfunction and jaundice in 23 (57.5%) patients, renal failure in 18 (45%) patients, severe anemia in 13 (32.5%) patients, cerebral malaria in 5 patients (12.5%), acute respiratory distress syndrome in 4 patients (10%), shock in 3 patients (7.5%), and hypoglycemia in 1 (2.5%) patient. Thrombocytopenia was observed in 5 (12.5%) patients, and multi-organ dysfunction was detected in 19 (47.5%) patients. Further large-scale multicentric epidemiologic studies are needed to define the basic pathology of this less known entity.

Clinical spectrum and treatment outcome of severe malaria caused byPlasmodium vivaxin 18 children from northern India

“…P. vivax is increasingly recognized as an important cause of severe malaria in children with clinical manifestations like cerebral malaria, anaemia, and thrombocytopenia. [1][2][3][4] In a large prospective study from Bikaner district of North India, 150 children admitted with severe malaria were analyzed, and it was observed that P. vivax monoinfection contributed to one third of cases. 3 It was also seen that children under 5 years infected with P. vivax infection had higher risk of developing severe malaria when compared to those infected with P. falciparum [OR 2.3 (1.4-3.76)].…”

“…Recently, P. vivax is being increasingly recognized as one of the etiological factors for severe malaria in children and adults. [1][2][3][4] The clinical presentation of severe malaria caused by P. falciparum and P. vivax were similar among children from Papau New Guinea except for higher chances of respiratory distress among the latter. 1 In a large prospective study from Bikaner district of North India, it was found that a proportion of under five children infected with P. vivax had a greater propensity for development of complications including severe anaemia, thrombocytopenia, cerebral malaria, acute respiratory distress syndrome, hepatic dysfunction, renal dysfunction, and abnormal bleeding.…”

Whole-genome sequencing and microarray analysis of ex vivo Plasmodium vivax reveal selective pressure on putative drug resistance genes

“…First, recent reports indicate that severe vivax malaria occurs and is understudied (3)(4)(5). Second, as happened previously with Plasmodium falciparum, chloroquine-resistant and multidrugresistant P. vivax strains are emerging (3,(6)(7)(8)(9).…”

Diagnosis and Treatment of Plasmodium vivax Malaria

“…Severe and fatal vivax malaria has been reported from Indonesia, 52,53 Papua New Guinea, 54 India, 55 and Brazil. 56,57 The main manifestations are anemia and respiratory distress, 53,[56][57][58][59][60][61][62] although series of patients with coma, shock, and renal and hepatic dysfunction associated with vivax malaria have also been described.…”

“…56,57 The main manifestations are anemia and respiratory distress, 53,[56][57][58][59][60][61][62] although series of patients with coma, shock, and renal and hepatic dysfunction associated with vivax malaria have also been described. [55][56][57]61,62 Plasmodium vivax is very sensitive to artemisinin and its derivatives. In the absence of comparative drug trials, physicians have tended to adopt a similar treatment approach for severe vivax malaria as for severe falciparum malaria, 1 namely administration of parenteral artesunate, if unavailable, artemether, and if that is also not available then quinine, along with broad-spectrum antibiotic cover and supportive care.…”