Abstract
BackgroundSevere and fatal vivax malaria is increasingly reported from India. In Mangaluru, southern India, malaria is focused in urban areas and associated with importation by migrant workers. In Wenlock Hospital, the largest governmental hospital, the clinical, parasitological and biochemical characteristics of malaria patients were assessed.MethodsDuring the peak malaria season in 2015 (June to December), outpatients were interviewed and clinically assessed. Malaria was ascertained by microscopy and PCR assays, concentrations of haemoglobin, creatinine and bilirubin, as well as thrombocyte count, were determined, and severe malaria was defined according to WHO criteria.ResultsAmong 909 malaria patients, the vast majority was male (93%), adult (median, 26 years) and of low socio-economic status. Roughly half of them were migrants from beyond the local Karnataka state, mostly from northern and northeastern states. Vivax malaria (69.6%) predominated over mixed Plasmodium vivax–Plasmodium falciparum infection (21.3%) and falciparum malaria (9.0%). The geometric mean parasite density was 3412/µL. As compared to vivax malaria, patients with falciparum malaria had higher parasite density and more frequently showed impaired general condition, affected consciousness and splenomegaly. Also, they tended to more commonly have anaemia and increased creatinine levels, and to be hospitalized (7.3%). Mixed-species infections largely assumed an interim position. Severe malaria (3.5%) was not associated with parasite species. No fatality occurred.ConclusionIn this study, uncomplicated cases of malaria predominated, with P. falciparum causing slightly more intense manifestation. Severe malaria was infrequent and fatalities absent. This contrasts with the reported pattern of manifestation in other parts of India, which requires the analysis of underlying causes.
Highlights
Severe and fatal vivax malaria is increasingly reported from India
Most of the patients were from a low socio-economic status (SES) background (Table 1)
In this study from the largest governmental hospital in urban Mangaluru, coastal southern India, almost 70% of malaria episodes were due to P. vivax and the vast majority of patients were managed as outpatients (96%)
Summary
Severe and fatal vivax malaria is increasingly reported from India. The country still contributes 6% of global malaria cases and accounts for approximately half of the total Plasmodium vivax cases worldwide [1, 2]. The role of mixed P. vivax–P. falciparum infections in terms of clinical manifestation and severity is not well established, not because of the very low sensitivity of conventional microscopy in detecting the minority species [12,13,14]. In mixed-species infections, both increased severity compared to P. vivax mono-infection but beneficial effects such as curbed peak P. falciparum parasite density have been observed [9, 11, 12, 15, 16]
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