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01.12.2012 | Research | Ausgabe 1/2012 Open Access

Malaria Journal 1/2012

Severe disease in children hospitalized with a diagnosis of Plasmodium vivax in south-eastern Pakistan

Zeitschrift:
Malaria Journal > Ausgabe 1/2012
Autoren:
Salma Shaikh, Hafeezullah Memon, Bhagchand Iohano, Amna Shaikh, Imran Ahmed, J Kevin Baird
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1475-2875-11-144) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

SS organized and supervised the collection of data from patient files. HM, AS, IA, and BI identified, collected, entered, and quality-assured the data from patient files. JKB advised on the collection, analysis, and reporting of the data. All authors contributed to writing the manuscript. All authors read and approved the final manuscript.

Abstract

Background

Infection by Plasmodium vivax has been considered rarely threatening to life, but recent studies challenge this notion. This study documented the frequency and character of severe illness in paediatric patients admitted to a hospital in south-eastern Pakistan with a laboratory-confirmed diagnosis of vivax malaria.

Methods

An observational study of all 180 paediatric patients admitted with any diagnosis of malaria during 2010 was conducted: 128 P. vivax; 48 Plasmodium falciparum; and four mixed infections of these species. Patients were classified as having severe illness with any of the following indicators: Glascow coma scale <11; ≥2 convulsions; haemoglobin <5g/dL; thrombocytes <50,000/mL; blood glucose <45mg%; >70 breaths/min; or intravenous anti-malarial therapy. Additionally, 64 patients with a diagnosis of vivax malaria were treated during 2009, and the 21 of these having severe illness were included in analyses of the frequency and character of severe illness with that diagnosis.

Results

During 2010, 39 (31%) or 37 (77%) patients with a diagnosis of P. vivax or P. falciparum were classified as having severe disease. Including the 2009 records of 64 patients having vivax malaria, a total of 60 (31%) patients with severe illness and a diagnosis of P. vivax were available. Altered mental status (Glascow coma scale score <11; or ≥2 convulsions) dominated at 54% of the 83 indicators of severe illness manifest among the patients with vivax malaria, as was true among the 37 children with a diagnosis of falciparum malaria and being severely ill; 58% of the 72 indicators of severe disease documented among them. No statistically significant difference appeared in frequencies of any other severe disease indicators between patients diagnosed with vivax or falciparum malaria. Despite such similarities, a diagnosis of falciparum malaria nonetheless came with 3.8-fold (95% CI = 1.8-8.1) higher risk of presenting with severe illness, and 8.0-fold (95% CI = 2.1-31) greater likelihood of presenting with three or more severe disease indicators. Two patients did not survive hospitalization, one each with a diagnosis of falciparum or vivax malaria.

Conclusions

Vivax malaria caused a substantial burden of potentially life-threatening morbidity on a paediatric ward in a hospital in south-eastern Pakistan.
Zusatzmaterial
Additional file 1 : Table S1. Case series summary of 21 patients classified as having severe disease with a diagnosis of vivax malaria during 2009. (DOC 51 KB)
12936_2012_2431_MOESM1_ESM.doc
Additional file 2 : Table S2. Case series summary of 39 patients classified as having severe disease with a diagnosis of vivax malaria during 2010. (DOC 80 KB)
12936_2012_2431_MOESM2_ESM.doc
Authors’ original file for figure 1
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Authors’ original file for figure 2
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Authors’ original file for figure 3
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Authors’ original file for figure 4
12936_2012_2431_MOESM6_ESM.pdf
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