Thrombocytopenia in childhood malaria with special reference toP. vivaxmonoinfection: A study from Bikaner (Northwestern India)

Abstract

Thrombocytopenia is commonly seen in Plasmodium vivax malaria, but its prognostic value has not been addressed in children. This prospective study included 676 admitted children of malaria [Plasmodium falciparum (Pf) monoinfection 262, Plasmodium vivax (Pv) monoinfection 380, and mixed (Pf + Pv) infection 34], in which thrombocytopenia (platelet count <150 × 10(3)/mm(3) on admission) was found in 442 (65.38%) children [Pf monoinfection 55.3% (145/262), Pv monoinfection 73.16% (278/380), and mixed infection 55.88% (19/34)]. The association of thrombocytopenia was statistically significant with Pv monoinfection [73.16% (278/380)] in comparison to either Pf monoinfection [55.34% (145/262); odds ratio (OR) = 2.199 (95% confidence interval (CI) 1.577-3.068), p < 0.0001] or mixed infection [55.88% (19/34); OR = 2.152 (95%CI 1.054-4.394), p = 0.032]. In Pv monoinfection, thrombocytopenia was highest in 0-5 years age group and subsequently decreased with advancing age, whereas in Pf monoinfection it was reverse. Severe thrombocytopenia (platelet count <20 × 10(3)/mm(3)) was present in 16.52% (73/442) children [Pv monoinfection 21.58% (60/278) and Pf monoinfection 8.97% (13/145)]. The risk of developing severe thrombocytopenia was also highest in Pv monoinfection [15.79% (60/380)] in comparison to Pf monoinfection [10.59% (13/262); OR = 3.591 (95%CI 1.928-6.690), p < 0.0001]. Bleeding manifestations were associated in 21.27% (94/442) children [Pf monoinfection 9.92% (26/262), Pv monoinfection 16.58% (63/380), and mixed malaria 14.71% (5/34)]. All the children having bleeding manifestations had thrombocytopenia but low platelet counts were not always associated with abnormal bleeding. The association of severe malaria was significantly more among children having Pv monoinfection with platelet counts <20 × 10(3)/mm(3) [OR = 2.569 (95%CI 1.196-5.517), p < 0.014] with specificity of 88.3% and positive predictive value of 85%. Till today, thrombocytopenia is not included in severe malaria criterion described by WHO, but when platelet counts <20 × 103/mm(3), we advocate it to include as one of the severe malaria criteria.

Comparison of Clinical Profile between P. vivax and P. falciparum Malaria in Children: A Tertiary Care Centre Perspective from India

“…Other authors from India also reported significantly higher proportion of thrombocytopenia in P. vivax . [12, 13]. …”

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

“…In a large prospective study from the Bikaner district of North India, they found thrombocytopenia in 73.16% (278/ 380) of children with P. vivax monoinfection, which was found to be significantly higher than either P. falciparum monoinfection [55.34%] or mixed infection [55.88%]. 11 The possible mechanisms for thrombocytopenia include direct lysis of platelets by P. vivax, immunological destruction by plateletassociated IgG antibody, and oxidative stress damage of thrombocytes.…”

Thrombocytopenia inPlasmodium vivaxMalaria: How Significant?

“…In another study, out of the 17 patients affected by any of the WHO malaria severity criteria with confirmed monoinfection, 14 presented with thrombocytopenia, suggesting that this hematological complication can be explored as a marker of severity for P. vivax [19]. Tanwar et al in 2012 reported significant association of severe malaria with platelet count <2 lac/cumm in children [25]. Kochar et al in 2009 studied adult patients and reported all complications in patients with Plasmodium vivax malaria [26].…”