Study of Severe Malaria Caused by Plasmodium Vivax in Comparison to Plasmodium Falciparum and Mixed Malarial Infections in Children

Abstract

Background: Malaria alone is responsible for major proportion of morbidity and mortality in children. Most cases of malaria are due to P.vivax. P.vivax has always been considered benign but recent studies and molecular studies are giving evidences towards increasing virulence and severity of P.vivax Aims and objective: Aim of this study was to observe severe malaria caused by P.vivax in comparison to Falciparum and mixed malarial infections. Other added aim was to observe for concomitant bacterial infections, how it affects clinical outcome and role of antibiotics in such cases of severe malaria. Materials and methods: This was a hospital based study conducted in a tertiary care center in Uttar Pradesh. Patients were tested for malaria using Peripheral blood smear and Rapid malaria antigen test. Total of 200 cases of severe malaria were enrolled in study. Patients were categorized as severe malaria on basis of WHO guidelines. Results: Of 200 cases of severe malaria, 130 (65%) had P.vivax infection, 31 (15.5%) had falciparum infection and 39 (19.5%) had mixed infection with both the species. Noteworthy results observed in cases of severe malaria with P.vivax infections were cerebral malaria (29.2%), severe anemia (26.9 %), severe thrombocytopenia (7.6%) and mortality (13%). Almost 15 % of total patients had concomitant bacterial infections that contributed significantly towards morbidity and prolonged hospitalization. Conclusion: From our study we observed that P.vivax cannot more be considered benign and needs quick diagnosis, prompt treatment and should be observed for complications. Antibiotics use should be considered in severe malaria.