The clinicopathologic manifestations of plasmodium vivax malaria in children

Abstract

Background: Plasmodium vivax is generally benign and complications leading to significant morbidity and mortality are uncommon,but in recent times it is being seen increasingly as complicated disease in various manifestations. Studies done on this increasing virulence of P. Vivax in children, are very rare. Objectives: This study was done with the intention of finding out spectrum of severe malaria complicationswhich are associated with P. vivax in children.Patients with mixed malarial infection were excluded by appropriate tests, to improve the diagnostic accuracy. The present study was focused on the pediatric population with a sample size of 30 subjects. Material and Methods : This was an observational retrospective analysis of the clinicopathologic manifestations of the Pediatric cases which were admitted with severe malaria due to a mono-infection with Plasmodium vivax, in a tertiary-care centre in the Uttar Pradesh, India. The diagnosis of the mono-infection with P. Vivax malaria was established by making peripheral blood films (PBFs) or by doing rapid diagnostic tests or by both methods. The severe forms of malaria were categorized as per the World Health Organization guidelines and the clinical and laboratory findings in these cases of complicated malaria were studied. A descriptive statistical analysis was done by using the SPSS software and an Excel worksheet. Results: This comprehensive study revealed a multisystem involvement. Abdominal manifestations were observed in 22(73.3%) cases (which included hepatosplenomegaly, hepatomegaly, splenomegaly and ascites) and hepatic dysfunction and jaundice were observed in 9(30%) cases. The hematological tests showed moderate to severe anemia in 17(56.6%) cases and thrombocytopenia in 25(83.3%) cases. Petechiae were noted in 1(3%) cases and a gross bleeding was noted in 7(23.3%) cases. Renal dysfunction was noted clinically in 3(10 %) cases and biochemically in 5(16.6%) cases. Shock was observed in 1(3%) cases, cerebral malaria was observed in 7(23.3%) cases and hypoglycemia was observed in 1(3%) cases. Conclusion: This study shows that P.Vivax malaria can indeed run a course with numerous complications. This can be because of increased virulence which has resulted in the changing picture of P. vivax malaria, considered to cause benign tertian malaria. Further studies should be undertaken to assess the role of malnutrition,concurrent infections and underlying diseases in patient with severe P. vivax malaria.