Severe Plasmodium vivax Malaria in Children: An emerging threat

Abstract

Plasmodium vivax was previously considered a relatively benign infection. This perception, however, has changed in recent years, and P.vivax has become recognized as a cause of severe malarial disease .The current knowledge on severe malaria has focused on P.falciparum and there is little information on the contribution of P.vivax to severe disease especially in children. Hence the present study was designed to study the clinicopathological profile of severe Plasmodium vivax malaria in children. In this study, records of 81 children of suspected severe malaria, 0–15 years of age hospitalized in the Paediatrics Department, S.N Medical College, Agra from January 2010 to December 2011were reviewed. Cases were included if malaria was diagnosed  by microscopy(thick and thin smears) and rapid diagnostic tests. The rapid diagnostic test was conducted using one step malaria anti P.f/P.v. serum test using three lines –lateral flow chromatographic immunoassay for qualitative estimation of antibodies. WHO severity criteria for malaria was used to study the complication profile of the patients. Of 81children of suspected severe malaria, P.vivax, P.falciparum and mixed infection were diagnosed by microscopy and rapid diagnostic test in 27, 26 and 4 children respectively. Spontaneous bleeding was the most frequent complication in both P.vivax (29.62%) and P.falciparum (38.46%). Severe anaemia was more common in P.falciparum (30.76%) whereas cerebral malaria in P.vivax(18.51%). Our study emphasizes that P.vivax is a major cause (52.5%) of severe form disease in children.  P.falciparum is a known cause of severe malaria but P.vivax is now also emerging as a cause of severe malaria in children.