Recurrence in Plasmodium vivax malaria: a prospective cohort study with long follow-up from a coastal region in South-West India.

Divya Gandrala,Vishnu Teja Nallapati,Vasudeva Guddattu,Kavitha Saravu,Alekhya Lavu,Nitin Gupta

doi:10.12688/f1000research.109577.1

Divya Gandrala, Vishnu Teja Nallapati + Show 4 more

Open Access

https://doi.org/10.12688/f1000research.109577.1

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Abstract

Background: India is endemic for Plasmodium vivax(Pv) malaria. Despite a decrease in incidence, its elimination is hampered by recurrences. This study aimed to characterize recurrences in Pv malaria and study its association with primaquine (PQ) usage. Methods: Symptomatic adult Pv patients were followed-up for up to 23 months for recurrences. The time to recurrence was compared by the PQ dosage they received using a log-rank test. Results: Of the 294 malaria patients, 206 (70%) patients had Pv infection during the study period. A total of 20 (9.7%) recurrences were seen in 17 (8.2%) patients of Pv. The percentage of first-time recurrences were highest in the no PQ group (25%), followed by the weekly PQ group (20%), low dose daily PQ (8.2%) group, and high dose daily PQ group (3.1%). Conclusions: Recurrence in Pv malaria is common, especially in those who receive an inappropriate prescription of primaquine.

Highlights

Malaria is a major global health problem, with around 228 million reported cases alone in 2018, most due to Plasmodium falciparum (Pf ).[1]
All patients of either sex above 18 years of age who presented during the study period with fever and had malarial parasites on the quantitative buffy coat (QBC) examination were included in the study after taking written informed consent
A total of 294 malaria cases were enrolled during the study period, of which 206 (70%) were Plasmodium vivax (Pv), 79 (27%) were Pf, and 9 (3%) were mixed

Summary

Introduction

Malaria is a major global health problem, with around 228 million reported cases alone in 2018, most due to Plasmodium falciparum (Pf ).[1]. Recent reports have shown that malaria caused by Plasmodium vivax (Pv) can be severe. Despite a decline in the number of Malaria cases in India, the major roadblock to elimination is the tendency of Pv to relapse frequently, mainly when primaquine (PQ) is not prescribed or prescribed in sub-therapeutic dosage.[4,5]. The objective of the study was to calculate the incidence of recurrence in patients with Pv malaria and find the impact of PQ prescription practices on recurrence. Conclusions: Recurrence in Pv malaria is common, especially in those who receive an inappropriate prescription of primaquine

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