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Severity in Plasmodium vivax malaria claiming global vigilance and exploration--a tertiary care centre-based cohort study.

Saravu K, Rishikesh K, Kamath A, Shastry AB - Malar. J. (2014)

Bottom Line: Pulmonary oedema/acute respiratory distress syndrome was associated (P = 0.003) with mortality in vivax malaria.Retrospective design of this study possesses inherent limitations.Mounting complications and its broadening spectrum in 'not so benign' P. vivax warrants global vigilance for any probable impositions.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka, India. kavithasaravu@gmail.com.

ABSTRACT

Background: Mounting reports on severe Plasmodium vivax malaria from across the globe have raised concerns among the scientific community. However, the risk of P. vivax resulting in complicated malaria and mortality is not as firmly established as it is with Plasmodium falciparum. This study was conducted to determine the severity proportion and factors associated with severity in cases of vivax and falciparum malaria.

Methods: Adult patients microscopically diagnosed to have P. vivax/P. falciparum infections from the year 2007-2011 were evaluated based on their hospital records. Severe malaria was defined as per the World Health Organization's guidelines. Comparison was made across species and binary logistic regression was used to determine risk factors of severity.

Results: Of 922 malaria cases included in the study, P. vivax was the largest (63.4%, 95% confidence interval (CI) 60.3-66.5%) infecting species, followed by P. falciparum (34.4%, 95% CI 31.3-37.5%) and their mixed infection (2.2%, 95% CI 1.3-3.2%). Severity in P. vivax and P. falciparum was noted to be 16.9% (95% CI 13.9-19.9%) and 36.3% (95% CI 31.0-41.6%) respectively. Plasmodium falciparum had significantly higher odds [adjusted odds ratio (95% CI), 2.80 (2.04-3.83)] of severe malaria than P. vivax. Rising respiratory rate [1.29 (1.15-1.46)], falling systolic blood pressure [0.96 (0.93-0.99)], leucocytosis [12.87 (1.43-115.93)] and haematuria [59.36 (13.51-260.81)] were the independent predictors of severity in P. vivax. Increasing parasite index [2.97 (1.11-7.98)] alone was the independent predictor of severity in P. falciparum. Mortality in vivax and falciparum malaria was 0.34% (95% CI -0.13-0.81%) and 2.21% (95% CI 0.59-3.83%), respectively. Except hyperparasitaemia and shock, other complications were associated (P < 0.05) with mortality in falciparum malaria. Pulmonary oedema/acute respiratory distress syndrome was associated (P = 0.003) with mortality in vivax malaria. Retrospective design of this study possesses inherent limitations.

Conclusions: Plasmodium vivax does cause severe malaria and mortality in substantial proportion but results in much lesser amalgamations of multi-organ involvements than P. falciparum. Pulmonary oedema/acute respiratory distress syndrome in P. vivax infection could lead to mortality and therefore should be diagnosed and treated promptly. Mounting complications and its broadening spectrum in 'not so benign' P. vivax warrants global vigilance for any probable impositions.

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Flow chart of patients’ selection and distribution of severe malaria across species. RDT = Rapid diagnostic test.
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Fig1: Flow chart of patients’ selection and distribution of severe malaria across species. RDT = Rapid diagnostic test.

Mentions: A study based on the records in a tertiary care hospital was conducted from January 2007 to December 2011. Initially patients’ data were abstracted onto physical proforma and verified manually followed by constructing an electronic database, its validation and analysis. Patients of either gender, ≥18 years, hospitalized with acute malaria, diagnosed by both quantitative buffy coat and Leishman’s stained peripheral blood smears with the presence of asexual forms of P. vivax, P. falciparum or both, with or without gametocytes, were included. All cases with, co-existent, non-malarial febrile illnesses were excluded, Figure 1. Patients were managed by hospital physicians as per their clinical judgement and national guidelines.Figure 1


Severity in Plasmodium vivax malaria claiming global vigilance and exploration--a tertiary care centre-based cohort study.

Saravu K, Rishikesh K, Kamath A, Shastry AB - Malar. J. (2014)

Flow chart of patients’ selection and distribution of severe malaria across species. RDT = Rapid diagnostic test.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4248447&req=5

Fig1: Flow chart of patients’ selection and distribution of severe malaria across species. RDT = Rapid diagnostic test.
Mentions: A study based on the records in a tertiary care hospital was conducted from January 2007 to December 2011. Initially patients’ data were abstracted onto physical proforma and verified manually followed by constructing an electronic database, its validation and analysis. Patients of either gender, ≥18 years, hospitalized with acute malaria, diagnosed by both quantitative buffy coat and Leishman’s stained peripheral blood smears with the presence of asexual forms of P. vivax, P. falciparum or both, with or without gametocytes, were included. All cases with, co-existent, non-malarial febrile illnesses were excluded, Figure 1. Patients were managed by hospital physicians as per their clinical judgement and national guidelines.Figure 1

Bottom Line: Pulmonary oedema/acute respiratory distress syndrome was associated (P = 0.003) with mortality in vivax malaria.Retrospective design of this study possesses inherent limitations.Mounting complications and its broadening spectrum in 'not so benign' P. vivax warrants global vigilance for any probable impositions.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka, India. kavithasaravu@gmail.com.

ABSTRACT

Background: Mounting reports on severe Plasmodium vivax malaria from across the globe have raised concerns among the scientific community. However, the risk of P. vivax resulting in complicated malaria and mortality is not as firmly established as it is with Plasmodium falciparum. This study was conducted to determine the severity proportion and factors associated with severity in cases of vivax and falciparum malaria.

Methods: Adult patients microscopically diagnosed to have P. vivax/P. falciparum infections from the year 2007-2011 were evaluated based on their hospital records. Severe malaria was defined as per the World Health Organization's guidelines. Comparison was made across species and binary logistic regression was used to determine risk factors of severity.

Results: Of 922 malaria cases included in the study, P. vivax was the largest (63.4%, 95% confidence interval (CI) 60.3-66.5%) infecting species, followed by P. falciparum (34.4%, 95% CI 31.3-37.5%) and their mixed infection (2.2%, 95% CI 1.3-3.2%). Severity in P. vivax and P. falciparum was noted to be 16.9% (95% CI 13.9-19.9%) and 36.3% (95% CI 31.0-41.6%) respectively. Plasmodium falciparum had significantly higher odds [adjusted odds ratio (95% CI), 2.80 (2.04-3.83)] of severe malaria than P. vivax. Rising respiratory rate [1.29 (1.15-1.46)], falling systolic blood pressure [0.96 (0.93-0.99)], leucocytosis [12.87 (1.43-115.93)] and haematuria [59.36 (13.51-260.81)] were the independent predictors of severity in P. vivax. Increasing parasite index [2.97 (1.11-7.98)] alone was the independent predictor of severity in P. falciparum. Mortality in vivax and falciparum malaria was 0.34% (95% CI -0.13-0.81%) and 2.21% (95% CI 0.59-3.83%), respectively. Except hyperparasitaemia and shock, other complications were associated (P < 0.05) with mortality in falciparum malaria. Pulmonary oedema/acute respiratory distress syndrome was associated (P = 0.003) with mortality in vivax malaria. Retrospective design of this study possesses inherent limitations.

Conclusions: Plasmodium vivax does cause severe malaria and mortality in substantial proportion but results in much lesser amalgamations of multi-organ involvements than P. falciparum. Pulmonary oedema/acute respiratory distress syndrome in P. vivax infection could lead to mortality and therefore should be diagnosed and treated promptly. Mounting complications and its broadening spectrum in 'not so benign' P. vivax warrants global vigilance for any probable impositions.

Show MeSH
Related in: MedlinePlus