Are respiratory complications of Plasmodium vivax malaria an underestimated problem?

Abstract

BackgroundRespiratory complications are uncommon, but often life-threatening features of Plasmodium vivax malaria. This study aimed to estimate the prevalence and lethality associated with such complications among P. vivax malaria patients in a tertiary hospital in the Western Brazilian Amazon, and to identify variables associated with severe respiratory complications, intensive care need and death. Medical records from 2009 to 2016 were reviewed aiming to identify all patients diagnosed with P. vivax malaria and respiratory complications. Prevalence, lethality and risk factors associated with WHO defined respiratory complications, intensive care need and death were assessed.ResultsA total of 587 vivax malaria patients were hospitalized during the study period. Thirty (5.1%) developed respiratory complications. Thirteen (43.3%) developed severe respiratory complications, intensive care was required for 12 (40%) patients and 5 (16.6%) died. On admission, anaemia and thrombocytopaenia were common findings, whereas fever was unusual. Patients presented different classes of parasitaemia and six were aparasitaemic on admission. Time to respiratory complications occurred after anti-malarials administration in 18 (60%) patients and progressed very rapidly. Seventeen patients (56.7%) had comorbidities and/or concomitant conditions, which were significantly associated to higher odds of developing severe respiratory complications, need for intensive care and death (p < 0.05).ConclusionRespiratory complications were shown to be associated with significant mortality in this population. Patients with comorbidities and/or concomitant conditions require special attention to avoid this potential life-threatening complication.Electronic supplementary materialThe online version of this article (10.1186/s12936-017-2143-y) contains supplementary material, which is available to authorized users.

Plasmodium vivax Parasite Load Is Associated With Histopathology in Saimiri boliviensis With Findings Comparable to P vivax Pathogenesis in Humans

“…Alveolar wall thickening with macrophage infiltration, type II pneumocyte hyperplasia and collagen deposition, and histological evidence of pulmonary edema were all evident in the S boliviensis tissues. Respiratory complications in vivax malaria have been well documented [ 13 , 25–27 ] and associated with significant mortality in humans [ 28 ], and P vivax iRBCs have been visualized in the lungs of autopsy cases [ 2 ]. Periportal inflammation, sinusoidal congestion, and Kupffer cell hyperplasia have been demonstrated here and with severe P falciparum malaria [ 29 ].…”

Perfil epidemiológico de la malaria grave en recién nacidos y adolescentes atendidos en 2016 en un hospital de referencia en el Estado de Amapá, Brasil

“…Los signos y síntomas respiratorios y las complicaciones pulmonares han sido objeto de un estudio. Val et al (2017) mostró que las complicaciones respiratorias se asociaron significativamente con casos de pacientes con malaria grave que murieron. Carvalho et al (2010) informó que P. Vivax tiene la capacidad de adherirse a las células endoteliales pulmonares humanas.…”

Management of Severe Malaria

“…In one series a higher percentage of patients with P. vivax required ICU admission that P. falciparum and the mortality was higher (22.9% versus 5.6%, p < 0.05)), with ARDS being nearly twice as common in the P. vivax patients (45.7% versus 23.3%, p = 0.06) [9]. In patients with P.vivax respiratory decom- pensation may be preceded by administration of antimalarials and progress rapidly [10].…”