Severe Plasmodium vivax Malaria in Children: An emerging threat
Plasmodium vivax was previously considered a relatively benign infection. This perception, however, has changed in recent years, and P.vivax has become recognized as a cause of severe malarial disease .The current knowledge on severe malaria has focused on P.falciparum and there is little information on the contribution of P.vivax to severe disease especially in children. Hence the present study was designed to study the clinicopathological profile of severe Plasmodium vivax malaria in children. In this study, records of 81 children of suspected severe malaria, 0–15 years of age hospitalized in the Paediatrics Department, S.N Medical College, Agra from January 2010 to December 2011were reviewed. Cases were included if malaria was diagnosed by microscopy(thick and thin smears) and rapid diagnostic tests. The rapid diagnostic test was conducted using one step malaria anti P.f/P.v. serum test using three lines –lateral flow chromatographic immunoassay for qualitative estimation of antibodies. WHO severity criteria for malaria was used to study the complication profile of the patients. Of 81children of suspected severe malaria, P.vivax, P.falciparum and mixed infection were diagnosed by microscopy and rapid diagnostic test in 27, 26 and 4 children respectively. Spontaneous bleeding was the most frequent complication in both P.vivax (29.62%) and P.falciparum (38.46%). Severe anaemia was more common in P.falciparum (30.76%) whereas cerebral malaria in P.vivax(18.51%). Our study emphasizes that P.vivax is a major cause (52.5%) of severe form disease in children. P.falciparum is a known cause of severe malaria but P.vivax is now also emerging as a cause of severe malaria in children.
World Health Organization (WHO) .World malaria report 2009. Geneva.http://www.who.int /malaria/ world_malaria_report_2009/en/. Accessed on 8 june, 20
National Drug Policy On Malaria (2010). Available at http://nvbdcp.gov.in/Doc/drug-policy- 2010.pdf . Accessed on 8 june, 2013
Arboleda M, Pérez MF, Fernández D, Usuga LY, Meza M. Clinical and laboratory profile of Plasmodium vivaxmalaria patients hospitalized in Apartadó, Colombia. Biomedica. 2012; 32:58-67. Srivastava S, Ahmad S, Shirazi N, Kumar Verma S, Puri P. Retrospective analysis of vivax malaria patients presenting to tertiary referral centre of Uttarakhand. Acta Trop. 2011;117(2):82-5.
Kochar DK, Tanwar GS, Khatri PC, Kochar SK, Sengar GS, et al. Clinical features of children hospitalized with malaria-a study from Bikaner, northwest India. Am J Trop Med Hyg. 2010;83:981– 9
World Health Organization (WHO).Guidelines for the treatment of Malaria. 2010. 2nd edition. Geneva.
Barcus MJ, Basri H, Picarima H, Manyakori C, Sekartuti, et al. Demographic risk factors for severe and fatal vivax and falciparum malaria among hospital admissions in northeastern Indonesian papua. Am J Trop Med Hyg. 2007;77:984–991.
Ellen FCL, Belisa M L M, Sheila VS, André MS, Silvana GB, Márcia A AA, Connor OB, Quique Bt, Marcus VGL. Risk Factors and Characterization of Plasmodium Vivax-Associated Admissions to Pediatric Intensive Care Units in the Brazilian Amazon.PLoS One. 2012; 7:e35406.
Beg MA, Khan R, Baig SM, Gulzar Z, Hussain R, Smego RA Jr. Cerebral involvement in benign tertian malaria. Am J Trop Med Hyg. 2002;67:230– 2
Ozen M, Gungor S, Atambay M, Daldal N. Cerebral malaria owing to Plasmodium vivax: case report. Ann Trop Paediatr. 2006;26:141–144.
Carvalho BO, Lopes SC, Nogueira PA, Orlandi PP, Bargieri DY, Blanco YC, Mamoni R, Leite JA, Rodrigues MM, Soares IS, Oliveira TR, Wunderlich G, Lacerda MV, del Portillo HA, Araşjo MO, Russell B, Suwanarusk R, Snounou G, Rénia L, Costa FT. On the cytoadhesion of Plasmodium vivax-infected erythrocytes. J Infect Dis. 2010;15;202(4):638-47.
Laurens M,Anna RU, Moses L, Henry E, Catriona M, Ivo M, Peter S, and Timothy ME Davis. A histopathologic study of fatal paediatric cerebral malaria caused by mixed Plasmodium falciparum/Plasmodium vivax infections. Malar J. 2012; 11: 107
Prakash J, Singh AK, Kumar NS, Saxena RK. Acute renal failure in Plasmodium vivaxmalaria. J Assoc Physicians India. 2003;51:265–267.
Nautiyal A, Singh S, Parmeswaran G, DiSalle M. Hepatic dysfunction in a patient with Plasmodium vivaxinfection. Med Gen Med. 2005;7:8
Blaise G,Valérie D, Lawrence R,Kay B, John C R,Michael P A, and Ivo M. Plasmodium vivax and Mixed Infections Are Associated with Severe Malaria in Children: A Prospective Cohort Study from Papua New Guinea. PLoS Med. 2008; 5: e127.
Sharma A, Khanduri U. How benign is benign tertian malaria? J Vector Borne Dis. 2009; 46:141-4.
Rodriguez-Morales AJ, Ferrer MV, Barrera MA, Pacheco M, Daza V, Franco-Paredes C. Imported cases of malaria admitted to two hospitals of Margarita Island, Venezuela, 1998-2005.Travel Med Infect Dis. 2009;7:44-8.