Clinical spectrum of Plasmodium vivax infection, from benign to severe malaria: A tertiary care prospective study in adults from Delhi, India

Abstract

Objective:Plasmodium vivax infection has been recognized to be a cause of severe malaria in recent time. We report findings from a prospective observational study aimed at analyzing the clinical spectrum, complications, and outcome of patients infected with P. vivax malaria.Materials and Methods:The study was conducted in a tertiary care hospital of Delhi over a period of 2 years. All adults hospitalized with P. vivax malaria, confirmed on peripheral smear and/or rapid diagnostic test, were included in the study. The cases were categorized into uncomplicated and severe malaria groups according to WHO criteria. The clinical and biochemical profile of cases in each group were compared for determining the predictors of severe malaria.Results:One hundred and fifty consecutive cases of P. vivax monoinfection were included in the study. All patients had fever, and 63 (42%) developed severe malaria, while 87 (58%) were uncomplicated. Vomiting, abdominal pain, headache, altered consciousness, cough with breathlessness, icterus, and hepatosplenomegaly were more frequent in severe malaria. Severe malaria was associated with severe thrombocytopenia, leucopenia, raised serum bilirubin, elevated serum creatinine, and prolonged prothrombin time. Jaundice (54 patients) was the most common complication, followed by acute respiratory distress syndrome, spontaneous bleeding, metabolic acidosis, shock, renal failure, and cerebral malaria. Multiple complications were observed in 17 (26.9%) cases of severe malaria. Overall mortality of 1.33% was recorded. However, case fatality of 40% was observed in cases with evidence of multiorgan dysfunction.Conclusion:P. vivax malaria has a varying clinical profile, from a relatively benign uncomplicated form to severe, even fatal disease. Certain clinical and laboratory parameters may serve as predictors of severe disease.

Clinical spectrum and predictors of severe <i>Plasmodium vivax </i>infections at a tertiary care center in North India

“…Even though elevations in urea over 50 mg/dL and severe anemia (hemoglobin below 7 gm/dL) were associated with severity, these were used to classify the infection as severe and cannot be used as predictors. Mortality occurred in 7% of vivax infections, much higher than reported estimates of 0.3% to 1.3% (10,11).…”

“…Prospective studies have shown that severe disease occurs in approximately 23% to 42% of vivax malaria infections (10,11). Thrombocytopenia is the most common "severe" manifestation of vivax infection (12).…”

“…A prolonged history of fever, dyspnea, and oliguria were more frequent in severe vivax infections in the present study. Serum bilirubin and urea levels have been shown to carry good discriminatory performance for severe vivax malaria (11), and the mean duration of fever and tachycardia at presentation predict poor outcome (13).…”

Trichinella spiralis co-infection exacerbates Plasmodium berghei malaria-induced hepatopathy

“…It has been reported that hepatosplenomegaly is more frequent in severe malaria [30]. Young children during malaria attacks have lymphocyte infiltrations in hepatic sinusoids, hyperplasia of Kupffer cells, and deposits of malaria pigment [31].…”

Genetic Diversity of Human Host Genes Involved in Immune Response and the Binding of Malaria Parasite in Patients Residing along the Thai-Myanmar border

“…Cerebral malaria is one of the most significant forms of severe malaria involving the two major pathogenesis processes, i.e., cytoadherence and immunogenic reactions. Most cases of cerebral malaria are due to P. falciparum infection, whereas P. vivax infection rarely causes cerebral malaria [3].…”