Plasmodium falciparum (Pf) is associated with numerous complications and high mortality, whereas Plasmodium vivax (Pv) infection is generally considered to be benign. However, severe complications, such as acute respiratory distress syndrome (ARDS) in Pv infection, are emerging. This case report highlights the complication of ARDS during the course of Pv infection in a 60-year-old woman. The diagnosis of the patient was made using microscopy, immunochromatography, and polymerase chain reaction assays for Pf and Pv species. The data indicated the presence of mono-Pv infection in the patient's blood, and Pf infection was specifically ruled out. The patient was discharged after intensive supportive care and antimalarial treatment. Pv infection is associated with ARDS and other complications such as sepsis and multi-organ dysfunction syndrome; this enhanced severity of Pv infection, if unrecognized, can lead to more deaths in malaria-endemic areas.

Background: Chronic liver disease is an important cause of mortality as well as morbidity all over the world. Cirrhosis causes clinical manifestations extending beyond the liver. In patients with chronic liver disease, the cause of mortality is usually related to the liver pathology, but extrahepatic manifestations of chronic liver damage contribute significantly to the morbidity. With regards to the cardiovascular system, the manifestations are due to circulatory disturbances and cardiac dysfunction. Among all etiologies, cirrhotic cardiomyopathy is the cardiac dysfunction secondary to chronic liver disease. Objective: To study the echocardiographic abnormalities in patients with chronic liver disease. Materials and Methods: This was a cross-sectional study that was conducted on 80 patients in a tertiary care center. All etiologies for chronic liver disease were included. The diagnosis was confirmed by clinical features, laboratory and imaging criteria, and endoscopic evidence, and the duration of the abnormalities was to be persistent for more than six months. Echocardiography was done within one week of conducting the investigations. Echocardiography was done by the same cardiologist, who was a part of the study group, for all the patients. Results: The study cohort included 69 males and 11 females. The age ranged from 36 years to 76 years. The most common abnormality noted was left ventricular hypertrophy 48 (60%). Diastolic dysfunction was observed in 33 (41.5%). The other abnormalities noted include: left ventricular dilatation 5 (6.25%), dilated left atrium 13 (16.25%), increase in pulmonary artery pressure 15 (18.75%), and right ventricular dysfunction 10 (12.5%). Conclusion: Cirrhotic cardiomyopathy is a common but silent entity. A high index of suspicion is to be kept for this entity while managing patients with cirrhosis. The existence of this entity, if known, will be helpful in the management of patients during procedures or diseases that place stress on the heart. The use of newer modalities of imaging such as tissue Doppler imaging and two-dimensional speckle tracking echocardiography is more sensitive than conventional echocardiography for identifying cardiac dysfunction.

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