The online version of this article (doi:10.1186/1475-2875-11-144) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
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.
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.
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.
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.
Vivax malaria caused a substantial burden of potentially life-threatening morbidity on a paediatric ward in a hospital in south-eastern Pakistan.
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 112936_2012_2431_MOESM3_ESM.jpeg
Authors’ original file for figure 212936_2012_2431_MOESM4_ESM.jpeg
Authors’ original file for figure 312936_2012_2431_MOESM5_ESM.jpeg
Authors’ original file for figure 412936_2012_2431_MOESM6_ESM.pdf
Kitchen SF: Vivax malaria. Chapter 43. Malariology Vol. II, p. 1027. Edited by: Boyd MF. 1949, W.B. Saunders Co, Philadelphia
Kochar D, Saxena V, Singh N, Kochar S, Kumar V, Das A: Plasmodium vivax malaria. Emerg Inf Dis. 2005, 11: 132-134. 10.3201/eid1101.040519. CrossRef
Price RN, Tjitra E, Guerra CA, Yeung S, White NJ, Anstey NM: Vivax malaria: neglected and not benign. AmJTrop Med Hyg. 2007, 77 (Suppl 6): 79-87.
Hay SI, Guerra CA, Tatem AJ, Noor AM, Snow RW: The global distribution and population at risk of malaria: past, present and future. Lancet Inf Dis. 2004, 4: 327-336. 10.1016/S1473-3099(04)01043-6. CrossRef
Guerra CA, Howes RE, Patil AP, Gething PW, Van Boeckel TP, Temperley WH, Kabaria CW, Tatem AJ, Manh BH, Elyazar IRF, Baird JK, Snow RW, Hay SI: The international limits and population at risk of Plasmodium vivax transmission in 2009. PLoS NTD. 2010, 4: e774-
Prybylski D, Khaliq A, Fox E, Sarwari AR, Strickland GT: Parasite density and malaria morbidity in the Pakistani Punjab. AmJTrop Med Hyg. 1999, 61: 791-801.
Arain A, Shaikh S, Shaikh A: Study of malaria in children at Liaquat Medical College Hospital. Pakistan Ped J. 1997, 21: 95-97.
Ng OT, Ooi EE, Lee CC, Lee PJ, Ng LC, Wong PS, Tu TM, Loh JP, Leo YS: Naturally acquired human Plasmodium knowlesi infection, Singapore. Emerg Inf Dis. 2008, 14: 814-816. 10.3201/eid1405.070863. CrossRef
Maguire JD, Lederman ER, Marcus MJ, O’Meara WA, Jordon RG, Muth S, Sismadi P, Bangs MJ, Prescott WR, Baird JK, Wongsrichanalai C: Production and validation of durable, high quality standardized malaria microscopy slides for teaching, testing and quality assurance during an era of declining diagnostic proficiency. Malar J. 2006, 5: 92-10.1186/1475-2875-5-92. PubMedCentralCrossRefPubMed
World Health Organization: Severe falciparum malaria. Trans R Soc Trop Med Hyg. 2000, 94 (suppl. 1): 1-90. CrossRef
Kochar DK, Tanwar GS, Khatri PC, Kochar SK, Sengar GS, Gupta A, Kochar A, Middha S, Acharya J, Saxena V, Pakalapati D, Garg S, Das A: Clinical features of children hospitalized with malaria – a study from Bikaner, Northwest India. AmJTrop Med Hyg. 2010, 83: 981-989. CrossRef
Saharan S, Kohli U, Lodha R, Sharma A, Bagga A: Thrombotic microangiopathy associated with Plasmodium vivax malaria. J Pediatric Nephrology. 2009, 24: 623-624. 10.1007/s00467-008-0945-4. CrossRef
Devidayal , Jabbar Z, Kumar S, Singh M: Acute renal failure and severe thrombocytopenia in a young boy with vivax malaria: case report. J Pediatr Inf Dis. 2008, 3: 145-147.
Thapa R, Patra V, Kundu R: P. vivax cerebral malaria. Indian Pediatr. 2007, 44: 433-434. PubMed
Barcus MJ, Basri H, Picarema H, Manyakori C, Sekartuti , Elyazar I, Bangs MJ, Maguire JD, Baird JK: Demographic risk factors for severe and fatal vivax and falciparum malaria among hospital admissions in northeastern Indonesian Papua. AmJTrop Med Hyg. 2007, 77: 984-991.
PATH: Staying the course? Malaria research and development in a time of economic uncertainty. 2011, PATH, Seattle
- Severe disease in children hospitalized with a diagnosis of Plasmodium vivax in south-eastern Pakistan
J Kevin Baird
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II