Clinical profile of plasmodium vivax malaria

Abstract

Long considered a benign infection, Plasmodium vivax is now recognised as a cause of severe and fatal malaria despite its low parasitic biomass, the increased deformability of vivax-infected red blood cells, and an apparent paucity of parasite sequestration. Severe malaria due to P. vivax infection is increasingly observed now-a-days with multiple organ failures. In this study we have presented P. vivax clinical profile and compared the risk factors and morality in vivax with falciparum infection. Material and methods: All acute febrile patients were screened for malaria parasites by peripheral blood smear and rapid diagnosis test (RDT). Patients with co-existent P. vivax and P. falciparum infection were excluded from this study, and detailed history and examination findings were recorded. All of them were subjected to routine haematological, urine, and biochemical investigations with parasite count. All of them were followed till the last, i.e., up to full recovery or death. Results: 418 cases of malaria from Haldwani, Bareilly, and Gorakhpur were included in this study, of whom 187 of P. vivax and 231 of P. falciparum malaria, 124 cases of P. vivax malaria cases were from Gorakhpur (East UP). Maximum number of cases were seen during wet season, i.e., July to September (54%). During this period they were severe with increased parasitaemia. Amongst 187 cases of P. vivax there were 124 males and 63 females with mean ± SD of 36.2 ± 9.8 years. Typical paroxysm of intermittent fever was seen in 90.9%, continuous fever in 5.3 %, jaundice in 33.1%, hypotension in 14.9% cases. Thrombocytopenia (platelets < 10,000/cu mm) was commonly seen in 58.2% cases of whom 13.9% had platelets < 40,000/cu mm with bleeding manifestation in 9.1 % cases. Other complications seen were hepatic 11.7%, renal 14.4%, cerebral (convulsions 4.8%, coma 2.1%) 6.9%and pulmonary involvement in 3.2% cases. Mortality (8.5%) increased with advancing age (above 50 years 75%) in vivax malaria whereas in falciparum it was 12.5%. Conclusion: Vivax malaria is now-a-days common with increased mortality which increases with advancing age. Thrombocytopenia is very common in vivax malaria. The renal, hepatic, cerebral involvement occurs with increasing frequency. Advancing age metabolic acidosis parasitaemia and multiorgan failure are the risk factors with fatal outcome.