Cause Of Severe Malaria Research Articles

Application of Machine Learning in the Development of Fourth Degree Quantitative Structure-Activity Relationship Model for Triclosan Analogs Tested against Plasmodium falciparum 3D7.

Despite new therapies against malaria, this disease remains one of the main causes of death affecting humanity. The phenomenon of resistance has caused concern as the drugs no longer have the same efficacy, forcing scientific research to develop new methods that prospect new molecules. With the advancement of artificial intelligence, it becomes possible to apply machine learning (ML) techniques in the discovery and evaluation of new molecules, by employing the quantitative structure-activity relationship (QSAR), a classic method that uses regressions to create a model that allows identifying and evaluating new drug candidates. This work combined QSAR with ML and developed a supervised model that modeled a fourth degree polynomial equation capable of identifying new drug candidates derived from the triclosan compound-a classic inhibitor of Plasmodium falciparum growth, the cause of severe malaria. The model produces an R 2 greater than 80% for training and concurrent testing, as well as a correlation index greater than 80% between the calculated and experimental pEC50 (negative logarithm of half maximal effective concentration) data. In addition, a web software (PlasmoQSAR) was created that allows researchers to calculate the EC50 (half maximal effective concentration) of new molecules using the developed analytical method.

Small heat shock proteins as modulators of cell death in Plasmodium falciparum parasites and its human host

Plasmodium falciparum, the predominant cause of severe malaria, thrives within both poikilotherm mosquitoes and homeotherm humans, navigating challenging temperature shifts during its life cycle. Survival in such varying environments necessitate the development of robust mechanisms, including a sophisticated protein folding system to mitigate proteopathy. The parasite needs to control the survival of its host cells which affects its chances of development and propagation. Central to this system are heat shock proteins (Hsps), among which small Hsps (sHsps) play pivotal roles in maintaining proteostasis (protein homeostasis). In both humans and P. falciparum, numerous sHsps have been identified, making them attractive candidates as biomarkers for diagnostic and drug development strategies. Evidence is accumulating suggesting that these sHsps participate in cell death processes, potentially influencing disease pathogenesis. Despite their significance, the precise functions of sHsps in P. falciparum’s adaptation to stress conditions remains largely unknown. Comparative structural analysis of sHsps between human and P. falciparum reveals species-specific variations. Despite conserved tertiary structures, unique motifs are found in parasite sHsps which may modulate specialised chaperone functions. This review discusses the conserved and distinctive motifs of sHsps from the human host and the parasite, offering insights into shared and unique attributes. These findings illuminate the potential for species-specific targeting of sHsps, as players in cell death processes that may foster innovative biomarker identification approaches. As malaria continues to ravage Sub-Saharan Africa, understanding the molecular intricacies guiding parasite survival are essential in the development of interventions with heightened efficacy against this global health crisis.

Trends in clinical features and severity of Plasmodium vivax malaria among children at tertiary care center in North India.

Malaria is a significant cause of morbidity and mortality in adults and children. Plasmodium falciparum is the primary cause of severe malaria, but recently Plasmodium vivax is also recognized to cause severe malaria-associated morbidity and mortality. The study focuses on determining the mortality related to severity parameters in individuals under 12 years and their critical presentation in P.vivax malaria-infected children. A prospective cross-sectional hospital-based study was conducted at Safdarjung Hospital, New Delhi, and ICMR-NIMR, New Delhi. All clinically suspected cases were admitted for screening. Exclusion criteria (rapid malaria antigen test, microscopy and medication history) were applied to all the admitted patients (n = 221) to obtain P.vivax patients only. Patients aged ≤ 12 years were included in the study. DNA was extracted from dried blood spots and amplified by nested PCR, followed by visualization on gel electrophoresis. A total of 221 clinically suspected cases of malaria were screened for P.vivax. After implementing various exclusion criteria, 45/221 cases were enrolled for the study, among which 44.4% (20/45) of children had the symptoms of severe malaria in terms of cerebral malaria, thrombocytopenia, anemia, pancytopenia, acute respiratory distress syndrome and hemophagocytic lymphohistiocytosis. Plasmodium vivax mono-infection can cause severe manifestation and must be treated as P.falciparum without any delay because it may lead to increased morbidity and mortality. A changing trend in clinical symptoms has shown in P.vivax which was an earlier phenomenon of P.falciparum.

Magnitude and patterns of severe Plasmodium vivax monoinfection in Vietnam: a 4-year single-center retrospective study.

Infection with Plasmodium vivax is a recognized cause of severe malaria including deaths. The exact burden and patterns of severe P. vivax monoinfections is however still not well quantified, especially in P. vivax endemic regions. We examined the magnitude and patterns of severe malaria caused by monoinfections of P. vivax and associated predictors among patients admitted to a tertiary care center for malaria in Vietnam. A retrospective cohort study was conducted based on the patients' medical records at the Hospital for Tropical Diseases from January 2015 to December 2018. Extracted information included demographic, epidemiologic, clinical, laboratory and treatment characteristics. Monoinfections with P. vivax were found in 153 (34.5, 95% CI 30.3-39.1%) patients of whom, uncomplicated and severe malaria were documented in 89.5% (137/153, 95% CI 83.7-93.5%) and 10.5% (16/153, 95% CI 6.5-16.3%), respectively. Patterns of severe malaria included jaundice (8 cases), hypoglycemia (3 cases), shock (2 cases), anemia (2 cases), and cerebral malaria (1 case). Among 153 patients, 73 (47.7%) had classic malaria paroxysm, 57 (37.3%) had >7 days of illness at the time of admission, and 40 (26.1%) were referred from other hospitals. A misdiagnosis as having other diseases from malaria cases coming from other hospitals was up to 32.5% (13/40). Being admitted to hospital after day 7th of illness (AOR = 6.33, 95% CI 1.14-35.30, p = 0.035) was a predictor of severe malaria. Severe malaria was statistically associated with longer hospital length of stay (p = 0.035). Early and late treatment failures and recrudescence were not recorded. All patients recovered completely. This study confirms the emergence of severe vivax malaria in Vietnam which is associated with delayed hospital admission and increased hospital length of stay. Clinical manifestations of P. vivax infection can be misdiagnosed which results in delayed treatment. To meet the goal of malaria elimination by 2030, it is crucial that the non-tertiary hospitals have the capacity to quickly and correctly diagnose malaria and then provide treatment for malaria including P. vivax infections. More robust studies need to be conducted to fully elucidate the magnitude of severe P. vivax in Vietnam.

Clinical characteristics and outcome of severe malaria in Kapit, Sarawak, Malaysian Borneo.

Severe malaria is a medical emergency and can lead to severe complications and death if not treated promptly and appropriately. Along with Plasmodium falciparum, P. knowlesi is increasingly recognised as a significant cause of fatal and severe malaria. We performed a retrospective review on 54 cases of severe malaria in a district hospital in Kapit, Sarawak, from January 2018 to May 2019. The patients' demographics, clinical features, complications based on organ involvement, and treatment outcomes were examined. There were 54 cases of severe malaria, with the majority being male (70%) and between the ages of 40 and 49 (26%). All patients with severe malaria were febrile or had a history of pyrexia except for one patient. P. knowlesi (81.5%) was the most common species causing severe malaria in our study, followed by P. falciparum (13%), and P. vivax (5.5%). There were no cases of severe malaria caused by P. ovale or P. malariae. Hyperparasitaemia was present in 76% of patients and the median parasitemia value at hospital admission was 33,944 parasites/μL (interquartile range: 19,920-113,285 parasites/μL). Circulatory shock was observed in 17 patients (31.5%). There were eight patients with acute renal failure and six patients with respiratory distress. One patient died as a result of severe malaria with multiorgan involvement (1.9% fatality rate). P. knowlesi is the most common cause of severe malaria in Kapit, Sarawak, Malaysia. Recognizing symptoms of severe malaria and prompt administration of antimalarial are critical for good clinical outcomes.

A study of clinical profile and outcome of malaria in adults at government general hospital, Nizamabad

What has to be stressed is the need to be cautious with such individuals and to broaden our differentials to include P. vivax as a possible cause of severe malaria. Patients who are aggressively handled and treated can have a better outcome.To study the clinical profile and outcome of malaria in adults at Government General Hospital in our local area. A Cross-sectional, observational study done in Department of general medicine in Fifty smear positive malaria patients admitted to the medical wards and intensive care units are included in the study. Study done for a period of 1 Year . Patients of either gender, above 18 years of age and below 60 years of age, diagnosed with malaria on peripheral smear were included in study.: A total number of 50 smear positive malaria patients were included in the study. Majority of the patients belongs to the age group of 18-30 years [36%] CNS findings: Altered Sensorium was seen in 20% patients and convulsions were seen in 20% patients. Complicated malaria was present in 76% patients and uncomplicated malaria was present in 24% patients. Complicated falciparum malaria was present in 30% patients and Complicated Vivax malaria was present in 46% patients. Uncomplicated falciparum malaria was present in 4% patients and Uncomplicated Vivax malaria was present in 20% patients. Mortality was seen in 6% patients. Mortality was seen in the age group of 41- 50 years [66.7%] and 31-40 years [33.3%]. : Malaria complications can be reduced by studying the clinical profile of the disease and using proper antimalarial medication treatment. This aids in the reduction of malaria morbidity and death, as well as the country's long-term economic prosperity.

Malaria in the Intensive Care Unit.

Most cases of severe malaria are caused by Plasmodium falciparum. Severe malaria is characterized by severe organ dysfunction. Both peripheral smear examination and rapid diagnostic test have a role in the diagnosis. Parenteral artesunate is clearly the drug of choice for the management of severe malaria. Parenteral artesunate should always be followed up with ACT.Most of the complications of severe malaria require supportive care only. The role of exchange transfusions in the management of severe malaria is questionable in the postartesunate era. Malaria in pregnancy can be quite severe and artesunate is now the drug of choice for all three trimesters. Vivax malaria is being increasingly recognized as a cause of severe malaria. The cause for this increased virulence is still not clear. Management of severe vivax malaria is similar to that of severe falciparum malaria.How to cite this article: Hegde A. Malaria in the Intensive Care Unit. Indian J Crit Care Med 2021;25(Suppl 2):S127–S129.

Epidemiological profile of serious malaria in newborns and adolescents served in 2016 in a reference hospital in the State of Amapá, Amazon Region, Brazil

The present study took into account not only Plasmodium falciparum infections that are commonly advocated as the main cause of severe malaria, but the complications related to Plasmodium vivax have been carefully described. The objective of this article was to identify the epidemiological, clinical and laboratory profile of severe malaria in patients attended at the Child and Adolescent Hospital in Macapá – Amapá. An epidemiological study, descriptive of retrospective character, was carried out. Data were obtained by consulting data bank for the year 2016. Severe malaria was considered in 47 cases. There were predominant male patients with 63.8% and the age group up to 5 years with 59.6% of the cases. As to the species, the most frequent infections were P. vivax with 72% in relation to P. falciparum with 28% of cases. The months with the greatest number of hospitalizations were September and November, both with 17%. The main clinical manifestations were: fever, pallor and cough. The conditions that indicated gravity that most occurred: vomiting 87%, jaundice 23%, dyspnoea and age <1 year both with 21%. Haematological examinations showed that 91% of the patients had red blood cells below the reference values and 100% of the cases had low hemoglobin and hematocrit; thrombocytopenia was observed in 72% of the cases. Altered results of biochemical dosages of major clinical importance were: urea, transaminases, glycyme and C-reactive protein. The identification of epidemiological, clinical and laboratory data of severe malaria contributes to the early diagnosis and appropriate treatment of the disease.

The use of proteomics for the identification of promising vaccine and diagnostic biomarkers in Plasmodium falciparum.

Plasmodium falciparum is the main cause of severe malaria in humans that can lead to death. There is growing evidence of drug-resistance in P. falciparum treatment, and the design of effective vaccines remains an ongoing strategy to control the disease. On the other hand, the recognition of specific diagnostic markers for P. falciparum can accelerate the diagnosis of this parasite in the early stages of infection. Therefore, the identification of novel antigenic proteins especially by proteomic tools is urgent for vaccination and diagnosis of P. falciparum. The proteome diversity of the life cycle stages of P. falciparum, the altered proteome of P. falciparum-infected human sera and altered proteins in P. falciparum-infected erythrocytes could be proposed as appropriate proteins for the aforementioned aims. Accordingly, this review highlights and proposes different proteins identified using proteomic approaches as promising markers in the diagnosis and vaccination of P. falciparum. It seems that most of the candidates identified in this study were able to elicit immune responses in the P. falciparum-infected hosts and they also played major roles in the life cycle, pathogenicity and key pathways of this parasite.

Severe malaria: update on pathophysiology and treatment

Malaria threatens the lives of over 200 million individuals with the disease each year. Plasmodium falciparum is the predominant cause of severe malaria which may be lethal and result in neurocognitive sequelae despite appropriate treatment. We review recent advances regarding the pathophysiology of severe malaria and treatment recommendations for severe disease in the United States. Infected red blood cell (iRBC) sequestration in microvascular beds is a critical factor in the development of severe malaria syndromes. Interactions between iRBC variant adhesive peptides and the endothelial protein C receptor (EPCR) result in perturbations of coagulation and cytopreservation pathways. Alterations in the protein C/EPCR axis are implicated in cerebral malaria, respiratory distress, and anemia. Brain MRIs reveal the posterior reversible encephalopathy syndrome in cerebral malaria patients. Transcriptomic analysis reveals commonalities in disease pathogenesis in children and adults despite differences in clinical presentation. US guidelines for severe malaria treatment currently recommend intravenous artesunate including in pregnant women and children. Despite advances in our understanding of malarial pathogenesis much remains unknown. Antimalarial agents eradicate parasites but no treatments are available to prevent or ameliorate severe malaria or prevent disease sequelae. Further study is needed to develop effective adjunctive therapies.

Divergent roles for the RH5 complex components, CyRPA and RIPR in human-infective malaria parasites.

Malaria is caused by Plasmodium parasites, which invade and replicate in erythrocytes. For Plasmodium falciparum, the major cause of severe malaria in humans, a heterotrimeric complex comprised of the secreted parasite proteins, PfCyRPA, PfRIPR and PfRH5 is essential for erythrocyte invasion, mediated by the interaction between PfRH5 and erythrocyte receptor basigin (BSG). However, whilst CyRPA and RIPR are present in most Plasmodium species, RH5 is found only in the small Laverania subgenus. Existence of a complex analogous to PfRH5-PfCyRPA-PfRIPR targeting BSG, and involvement of CyRPA and RIPR in invasion, however, has not been addressed in non-Laverania parasites. Here, we establish that unlike P. falciparum, P. knowlesi and P. vivax do not universally require BSG as a host cell invasion receptor. Although we show that both PkCyRPA and PkRIPR are essential for successful invasion of erythrocytes by P. knowlesi parasites in vitro, neither protein forms a complex with each other or with an RH5-like molecule. Instead, PkRIPR is part of a different trimeric protein complex whereas PkCyRPA appears to function without other parasite binding partners. It therefore appears that in the absence of RH5, outside of the Laverania subgenus, RIPR and CyRPA have different, independent functions crucial for parasite survival.

Clinical spectrum of Plasmodium vivax infection, from benign to severe malaria: A tertiary care prospective study in adults from Delhi, India.

Objective:Plasmodium vivax infection has been recognized to be a cause of severe malaria in recent time. We report findings from a prospective observational study aimed at analyzing the clinical spectrum, complications, and outcome of patients infected with P. vivax malaria.Materials and Methods:The study was conducted in a tertiary care hospital of Delhi over a period of 2 years. All adults hospitalized with P. vivax malaria, confirmed on peripheral smear and/or rapid diagnostic test, were included in the study. The cases were categorized into uncomplicated and severe malaria groups according to WHO criteria. The clinical and biochemical profile of cases in each group were compared for determining the predictors of severe malaria.Results:One hundred and fifty consecutive cases of P. vivax monoinfection were included in the study. All patients had fever, and 63 (42%) developed severe malaria, while 87 (58%) were uncomplicated. Vomiting, abdominal pain, headache, altered consciousness, cough with breathlessness, icterus, and hepatosplenomegaly were more frequent in severe malaria. Severe malaria was associated with severe thrombocytopenia, leucopenia, raised serum bilirubin, elevated serum creatinine, and prolonged prothrombin time. Jaundice (54 patients) was the most common complication, followed by acute respiratory distress syndrome, spontaneous bleeding, metabolic acidosis, shock, renal failure, and cerebral malaria. Multiple complications were observed in 17 (26.9%) cases of severe malaria. Overall mortality of 1.33% was recorded. However, case fatality of 40% was observed in cases with evidence of multiorgan dysfunction.Conclusion:P. vivax malaria has a varying clinical profile, from a relatively benign uncomplicated form to severe, even fatal disease. Certain clinical and laboratory parameters may serve as predictors of severe disease.

Identification of a Novel Clinical Phenotype of Severe Malaria using a Network-Based Clustering Approach

The parasite Plasmodium falciparum is the main cause of severe malaria (SM). Despite treatment with antimalarial drugs, more than 400,000 deaths are reported every year, mainly in African children. The diversity of clinical presentations associated with SM highlights important differences in disease pathogenesis that often require specific therapeutic options. The clinical heterogeneity of SM is largely unresolved. Here we report a network-based analysis of clinical phenotypes associated with SM in 2,915 Gambian children admitted to hospital with Plasmodium falciparum malaria. We used a network-based clustering method which revealed a strong correlation between disease heterogeneity and mortality. The analysis identified four distinct clusters of SM and respiratory distress that departed from the WHO definition. Patients in these clusters characteristically presented with liver enlargement and high concentrations of brain natriuretic peptide (BNP), giving support to the potential role of circulatory overload and/or right-sided heart failure as a mechanism of disease. The role of heart failure is controversial in SM and our work suggests that standard clinical management may not be appropriate. We find that our clustering can be a powerful data exploration tool to identify novel disease phenotypes and therapeutic options to reduce malaria-associated mortality.

Clinical and Laboratory Features Associated with Acute Kidney Injury in Severe Malaria.

Introduction:Critically ill severe malaria constitutes one of the major hospital admissions in Indian setting. Clinical studies identifying the factors associated with acute kidney injury (AKI) in malaria are lacking. This study aimed to identify these factors.Methods:This prospective observational study was conducted in a tertiary care center of North India. All adult patients with severe malaria were studied during 2012–2014.Results:The study included 79 patients and AKI was observed in 36 patients. Of these 79 patients, 52.7% were Plasmodium falciparum positive and 47.2% were Plasmodium vivax positive. In AKI patients, thrombocytopenia and jaundice were the most common other complications seen. Among P. vivax malarial patients, 17 (36%) patients had AKI. Features associated with AKI among patients admitted with P. vivax malaria were as follows: tachycardia (adjusted relative risk [RR]: 3.9; 95% confidence interval [CI]: 1.1–13.7), direct hyperbilirubinemia (adjusted RR: 4.7; 95% CI: 1.4–15.2), anemia (adjusted RR: 6; 95% CI: 1.7–22.4), and sepsis (adjusted RR: 3.3; 95% CI: 1.1–13.7). The presence of tachycardia, acidosis, cerebral malaria, acute respiratory distress syndrome/acute lung injury, hypotensive shock, and poor Glasgow Coma Scale were associated with higher mortality in patients with AKI. Patients who required mechanical ventilation and/or vasopressor support had higher mortality.Conclusion:P. vivax is an important cause of severe malaria with AKI in our setting. Various other clinical features are associated with AKI and related mortality.

Intravascular haemolysis with haemoglobinuria in a splenectomized patient with severe Plasmodium knowlesi malaria

BackgroundHaemoglobinuria is an uncommon complication of severe malaria, reflecting acute intravascular haemolysis and potentially leading to acute kidney injury. It can occur early in the course of infection as a consequence of a high parasite burden, or may occur following commencement of anti-malarial treatment. Treatment with quinine has been described as a risk factor; however the syndrome may also occur following treatment with intravenous artesunate. In Malaysia, Plasmodium knowlesi is the most common cause of severe malaria, often associated with high parasitaemia. Asplenic patients may be at additional increased risk of intravascular haemolysis.Case presentationA 61 years old asplenic man was admitted to a tertiary referral hospital in Sabah, Malaysia, with severe knowlesi malaria characterized by hyperparasitaemia (7.9 %), jaundice, respiratory distress, metabolic acidosis, and acute kidney injury. He was commenced on intravenous artesunate, but1 day later developed haemoglobinuria, associated with a 22 % reduction in admission haemoglobin. Additional investigations, including a cell-free haemoglobin of 10.2 × 105 ng/mL and an undetectable haptoglobin, confirmed intravascular haemolysis. The patient continued on intravenous artesunate for a total of 48 h prior to substitution with artemether–lumefantrine, and made a good recovery with resolution of his haemoglobinuria and improvement of his kidney function by day 3.ConclusionsAn asplenic patient with hyperparasitaemic severe knowlesi malaria developed haemoglobinuria after treatment with intravenous artesunate. There are plausible mechanisms for increased haemolysis with hyperparasitaemia, and following both splenectomy and artesunate. Although in this case the patient made a rapid recovery, knowlesi malaria patients with this unusual complication should be closely monitored for potential deterioration.

A Child with Severe Malaria Presenting with Acute Surgical Abdomen (Duodenal Perforation).

Plasmodium falciparum, the commonest cause of severe malaria in children, is an important cause of mortality in developing nations like Nepal. Duodenal perforation in a case of complicated malaria, although a rare entity, can occur in children. Early diagnosis, proper medical treatment, and early surgical repair can be a lifesaving measure in such cases. Here, we report a case of a 5-year-old male child with falciparum malaria complicated by a duodenal perforation that was successively managed with appropriate antimalarial drugs and early surgical repair.

Is Plasmodium vivax malaria a severe malaria?: a systematic review and meta-analysis.

Background Plasmodium vivax is one of the major species of malaria infecting humans. Although emphasis on P. falciparum is appropriate, the burden of vivax malaria should be given due attention. This study aimed to synthesize the evidence on severe malaria in P. vivax infection compared with that in P. falciparum infection.Methods/Principal FindingsWe searched relevant studies in electronic databases. The main outcomes required for inclusion in the review were mortality, severe malaria (SM) and severe anaemia (SA). The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Overall, 26 studies were included. The main meta-analysis was restricted to the high quality studies. Eight studies (n = 27490) compared the incidence of SM between P. vivax infection and P. falciparum mono-infection; a comparable incidence was found in infants (OR: 0.45, 95% CI:0.04–5.68, I 2:98%), under 5 year age group (OR: 2.06, 95% CI: 0.83–5.1, I 2:83%), the 5–15 year-age group (OR: 0.6, 95% CI: 0.31–1.16, I 2:81%) and adults (OR: 0.83, 95% CI: 0.67–1.03, I 2:25%). Six studies reported the incidences of SA in P. vivax infection and P. falciparum mono-infection; a comparable incidence of SA was found among infants (OR: 3.47, 95%:0.64–18.94, I 2: 92%), the 5–15 year-age group (OR:0.71, 95% CI: 0.06–8.57, I 2:82%). This was significantly lower in adults (OR:0.75, 95% CI: 0.62–0.92, I 2:0%). Five studies (n = 71079) compared the mortality rate between vivax malaria and falciparum malaria. A lower rate of mortality was found in infants with vivax malaria (OR:0.61, 95% CI:0.5–0.76, I 2:0%), while this was comparable in the 5–15 year- age group (OR: 0.43, 95% CI:0.06–2.91, I 2:84%) and the children of unspecified-age group (OR: 0.77, 95% CI:0.59–1.01, I 2:0%).ConclusionOverall, the present analysis identified that the incidence of SM in patients infected with P. vivax was considerable, indicating that P. vivax is a major cause of SM. Awareness of the clinical manifestations of vivax malaria should prompt early detection. Subsequent treatment and monitoring of complications can be life-saving.

Severe Plasmodium vivax Malaria in Children: An emerging threat

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.

Clinical Factors for Severity of Plasmodium falciparum Malaria in Hospitalized Adults in Thailand

Plasmodium falciparum is a major cause of severe malaria in Southeast Asia, however, there is limited information regarding clinical factors associated with the severity of falciparum malaria from this region. We performed a retrospective case-control study to compare clinical factors and outcomes between patients with severe and non-severe malaria, and to identify clinical factors associated with the requirement for intensive care unit (ICU) admission of patients with severe falciparum malaria among hospitalized adults in Southeast Asia. A total of 255 patients with falciparum malaria in the Hospital for Tropical Diseases in Bangkok, Thailand between 2006 and 2012 were included. We identified 104 patients with severe malaria (cases) and 151 patients with non-severe malaria (controls). Patients with falciparum malaria with following clinical and laboratory characteristics on admission (1) referrals, (2) no prior history of malaria, (3) body temperature of >38.5°C, (4) white blood cell counts >10×109/µL, (5) presence of schizonts in peripheral blood smears, and (6) albumin concentrations of <3.5 g/dL, were more likely to develop severe malaria (P<0.05). Among patients with severe malaria, patients who met ≥3 of the 2010 WHO criteria had sensitivity of 79.2% and specificity of 81.8% for requiring ICU admission. Multivariate analysis identified the following as independent associated factors for severe malaria requiring ICU admission; (1) ethnicity of Thai [odds ratio (OR) = 3.601, 95% confidence interval (CI) = 1.011–12.822] or Myanmar [OR = 3.610, 95% CI = 1.138–11.445]; (2) referrals [OR = 3.571, 95% CI = 1.306–9.762]; (3) no prior history of malaria [OR = 5.887, 95% CI = 1.354–25.594]; and (4) albumin concentrations of <3.5 g/dL [OR = 7.200, 95% CI = 1.802–28.759]. Our findings are important for the clinical management of patients with malaria because it can help early identification of patients that could develop severe malaria and require ICU admission. Early identification and the timely initiation of appropriate treatments may well improve the outcomes and reduce the mortality of these patients.

The unusual presentation of a usual organism - the changing spectrum of the clinical manifestations of Plasmodium vivax malaria in children: a retrospective study.

Malaria is a major public health problem in the south-east Asian region. Among all countries in the SE Asian region the highest number of cases and deaths are reported from India. Children below 14 years of age contribute to approximately 42% of all the deaths. A majority of the deaths are attributed to severe malaria which is caused by Plasmodium falciparum. It is considered that causes a benign causing febrile illness without significant complications. However, in recent years, the spectrum of is shifting from being the cause of benign fever, to more severe complications. There have been case reports of complications like thrombocytopaenia, cerebral malaria, a disseminated intravascular coagulation, the acute respiratory distress syndrome, hepatic dysfunction and renal involvement. Most of the case reports are from the adult population, with an occasional occurrence of paediatric cases. To highlight the increasing number of severe manifestations in P.vivax malaria in the children who were admitted in the malaria transmission season of 2011, at a tertiary care hospital. A descriptive, cross-sectional study. Children with an acute febrile illness of a duration of < 7 days, which was confirmed as Plasmodium vivax positive malaria by testing the peripheral smears and/or by Rapid Diagnostic Testing, who were admitted in the paediatric ward of a tertiary care hospital in New Delhi (India), during May 2011 to October 2011, Case records of context cases were analysed retrospectively. The data was summarised by calculating the rates, ratios, proportions, means, standard deviations and the 95% confidence intervals. The Chi square test was applied to assess the significant difference between two qualitative variables. Among the case records of 54 patients, 40.7% were below 5 years. 61% were males and 38.9% were females. Besides hepatomegaly and splenomegaly which were the most common symptoms, which were seen in 81.5% and 72.2% children respectively, the various unusual manifestations seen were severe thrombocytopaenia (37%), jaundice with deranged LFT values (25.9%), abnormal bleeding (18.5%), impaired consciousness with a GCS of < 9 (18.5%), severe anaemia (14.8%), hypotension (11.1%), repeated convulsions (7.6%), pulmonary oedema/ARDS (5.6%) and ascites (5.6%). One case each showed haemoglobinuria, and pleural effusion. Plasmodium vivax is emerging as a cause of severe malaria. There is a further need to study the pathophysiology, virulence factors and the molecular mechanisms which are involved in malaria.