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01.12.2012 | Review | Ausgabe 1/2012 Open Access

Malaria Journal 1/2012

Understanding the clinical spectrum of complicated Plasmodium vivax malaria: a systematic review on the contributions of the Brazilian literature

Malaria Journal > Ausgabe 1/2012
Marcus VG Lacerda, Maria PG Mourão, Márcia AA Alexandre, André M Siqueira, Belisa ML Magalhães, Flor E Martinez-Espinosa, Franklin S Santana Filho, Patrícia Brasil, Ana MRS Ventura, Mauro S Tada, Vanja SCD Couto, Antônio R Silva, Rita SU Silva, Maria GC Alecrim
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Electronic supplementary material

The online version of this article (doi:10.​1186/​1475-2875-11-12) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

MVGL and MGCA conceived the review. MAAA performed the bibliographical research and retrieved the references. MVGL drafted the manuscript. MPGM, AMS, BMLM, FEME, FSSF, PB, AMRSV, MST, VSCDC, ARS and RSUS critically revised the document. All authors read and approved the final manuscript.


The resurgence of the malaria eradication agenda and the increasing number of severe manifestation reports has contributed to a renewed interested in the Plasmodium vivax infection. It is the most geographically widespread parasite causing human malaria, with around 2.85 billion people living under risk of infection. The Brazilian Amazon region reports more than 50% of the malaria cases in Latin America and since 1990 there is a marked predominance of this species, responsible for 85% of cases in 2009. However, only a few complicated cases of P. vivax have been reported from this region. A systematic review of the Brazilian indexed and non-indexed literature on complicated cases of vivax malaria was performed including published articles, masters' dissertations, doctoral theses and national congresses' abstracts. The following information was retrieved: patient characteristics (demographic, presence of co-morbidities and, whenever possible, associated genetic disorders); description of each major clinical manifestation. As a result, 27 articles, 28 abstracts from scientific events' annals and 13 theses/dissertations were found, only after 1987. Most of the reported information was described in small case series and case reports of patients from all the Amazonian states, and also in travellers from Brazilian non-endemic areas. The more relevant clinical complications were anaemia, thrombocytopaenia, jaundice and acute respiratory distress syndrome, present in all age groups, in addition to other more rare clinical pictures. Complications in pregnant women were also reported. Acute and chronic co-morbidities were frequent, however death was occasional. Clinical atypical cases of malaria are more frequent than published in the indexed literature, probably due to a publication bias. In the Brazilian Amazon (considered to be a low to moderate intensity area of transmission), clinical data are in accordance with the recent findings of severity described in diverse P. vivax endemic areas (especially anaemia in Southeast Asia), however in this region both children and adults are affected. Finally, gaps of knowledge and areas for future research are opportunely pointed out.
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