Plasmodium vivax Induced Acute Respiratory Distress Syndrome – A Diagnostic and Therapeutic Dilemma in Preeclampsia

Abstract

A 27-year-old woman, G2P1L1 at 36 weeks gestation presented to our hospital with complaints of fever with chills and rigor since five days. There was no prior history of any obstetric or medical problems. She underwent lower segment caesarean section four years back for breech presentation.On examination, she was conscious and oriented, having mild pallor and icterus. Her temperature was 102.6°F, PR 128 bpm, RR 18/ min, BP 146/94 mmHg, O 2 saturation 100% at room air. Chest was clear with normal vesicular breathing and cardiovascular system. There was no hepatosplenomegaly and fundal height was 36 weeks, cephalic relaxed and fetal heart rate was 140 bpm regular. Laboratory investigation were -Hb 10.2 g%, TLC 8400, platelet count 1.2 L, random blood sugar was 84 mg/dl, serum electrolytes Na + 136 and K + 3.8 mg, total serum bilirubin was 2.82, indirect 2.14 and direct 0.68, SGOT/PT 69/60, blood urea 18 mg/dl and serum creatinine 0.7 mg/dl. Dipstick showed 1+ albuminuria. Viral markers, peripheral smear for malarial parasite and dengue serology were negative. Although widal was positive in titres of 1:160, urine and blood culture reported no growth. Ultrasound whole abdomen revealed mild splenomegaly. Provisional diagnosis of non severe preeclampsia with typhoid fever was made.

Malaria in pregnancy in India: a 50-year bird’s eye

“…Acute respiratory distress syndrome is diagnosed in malaria infected pregnant women at lower rates compared to SMA, CM, and ARF, with overall proportion of ~0-4% in states including Rajasthan, Gujarat, and Andhra Pradesh (Table 3). ARDS can pose a veritable diagnostic and therapeutic dilemma as previously reported in a Pv-infected preeclamptic pregnant woman (78). Kochar et al (81) reported that pulmonary edema occurred in 13.3% of malaria infected pregnant women just after delivery in Rajasthan.…”

“…Using systematic review and meta-analysis approach, we recently showed that the overall prevalence of SM in individuals with Pv mono-infection was 29.3% in India, with lowest and highest rates in Karnataka (15.3%) and Uttarakhand (57.8%), respectively ( 5 ). In pregnant women, data on SM prevalence are greatly missing in India, and the studies on clinical patterns of severe MiP are focused and/or have evaluated few particular presentations only (e.g., ARDS, CM) ( 77 , 78 ). One study from Karnataka reported that 32.4% of malaria-infected patients were diagnosed with SM, and Pv was the main contributor of SM cases (56.6%) ( 52 ).…”

“…Regarding comorbidities, mostly cardiovascular disorders such as eclampsia and pre-eclampsia were diagnosed in Pv –induced ARDS and CM cases in Delhi and Karnataka were seen ( 78 , 95 ). The effect of poor nutritional status on malaria risk is still elusive ( 96 ).…”

Sterile protection againstPlasmodium vivaxmalaria by repeated blood stage infection in a non-human primate model

“…Vivax malaria impacts the health of individuals of all ages causing repeated febrile episodes and severe anemia (15,17), clinical severity including hemolytic coagulation disorders, jaundice, coma, acute renal failure, rhabdomyolysis, porphyria, splenic rupture (4,18), and Acute Respiratory Distress Syndrome (ARDS) (19)(20)(21)(22). Fatal P. vivax cases are reported from all endemic regions across the globe (3,15,23).…”

Sterile protection againstP. vivaxmalaria by repeated blood stage infection in theAotusmonkey model

“…Complete removal of the parasite from the human reservoir is therefore challenging (4,13), underscoring the need for innovative therapeutic strategies including the development of an effective vaccine (14,15). P. vivax malaria impacts the health of individuals of all ages causing repeated febrile episodes and severe anemia (14,16), clinical severity including hemolytic coagulation disorders, jaundice, coma, acute renal failure, rhabdomyolysis, porphyria, splenic rupture (3,17), and acute respiratory distress syndrome (18,19,20,21). Fatal P. vivax cases are reported from all endemic regions across the globe (1,14,22).…”