Abstract
BackgroundInfection 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.MethodsAn 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.ResultsDuring 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.ConclusionsVivax malaria caused a substantial burden of potentially life-threatening morbidity on a paediatric ward in a hospital in south-eastern Pakistan.
Highlights
Infection by Plasmodium vivax has been considered rarely threatening to life, but recent studies challenge this notion
With almost three billion people living at risk of vivax malaria and at least 100 million clinical attacks annually [7,8], the frequency, character, and risks of life-threatening illness associated with a diagnosis of Plasmodium vivax represents a conspicuously important global health issue
Two paediatric patient populations composed distinct analytical approaches to the studies undertaken: 1) a retrospective case series of 21 patients diagnosed with P. vivax mono-infection and classified as having severe illness; and 2) observational study of the records of 176 patients diagnosed with either P. falciparum or P. vivax mono-infections and treated in the paediatric department (April to December 2010)
Summary
Infection by Plasmodium vivax has been considered rarely threatening to life, but recent studies challenge this notion. In Russell’s 1949 text of malariology [1], S.F. Kitchen wrote, “As a general rule vivax infections exhibit relatively benign characteristics. . .instances of death (of otherwise healthy adults) due to this parasite alone must be rare.”. “As a general rule vivax infections exhibit relatively benign characteristics. This remained the prevailing view of malariologists over the ensuing decades. Recently has evidence emerged suggesting that, on the contrary, life-threatening illness with a diagnosis of vivax malaria may often be encountered in many endemic settings [2,3,4,5,6]. With almost three billion people living at risk of vivax malaria and at least 100 million clinical attacks annually [7,8], the frequency, character, and risks of life-threatening illness associated with a diagnosis of Plasmodium vivax represents a conspicuously important global health issue
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