Changing profile of Plasmodium vivax malaria

Abstract

Background: Malaria, endemic in India, tends to be a major contributor to morbidity and mortality globally. Of the various species, Plasmodium Falciparum is associated with serious prognosis,( morbidity and mortality) in a sizeable number of patients. Chloroquine resistance was an important clinical issue; the current issue is that of an apparently changing scenario with rising number of P.Vivax malaria cases, associated with severity of complications. The observational study is aimed to find out whether there is change in P.Vivax malaria features and how it influences management. Methods & Materials: An observational study conducted at a teaching hospital in central metropolitan Mumbai, India during the monsoon months (June-October 2013). Febrile patients admitted from the medical outdoor and emergency service form the basis of this study. Patients with moderate to severe degree fever, with chills, localized and generalized body ache, varying degrees of weakness/fatigue and malaise/lethargy, vomiting suspected clinically to be suffering from malaria were tested - by peripheral smear examination/malaria specific Antigen. Other investigations included total and differential count, liver function tests- mainly Serum Bilirubin, Transaminases, renal function tests (Serum Creatinine). Haemodynamic Instability (hypotension), thrombocytopenia with manifest bleeding, affected renal function singly and in combination were the differentiating criteria towards critical care. Results: A total of 41 cases (29 M, 12 F) of malaria were diagnosed- 39 were P.vivax and 2 were mixed malaria. As many as 32 patients were found to be thrombocytopenic (platelet count < 1.5 lakhs), the range being from 12,000 to 1.4 lakhs/cumm. Seven patients (17%) presented with hypotension and required ICU monitoring. 14 patients (34%) had deranged liver function test mostly in the form of transaminitis and 3 cases with renal insufficiency.3 patient presented with bleeding. 7 patients required platelet transfusion (4 units each of Random Donor Platelet transfusion) and 1 patient required platelet transfusion twice. Patients who tested positive for Dengue Antigen fared poorly. Fluctuating and decreasing platelet count without bleeding contributed to prolongation of hospital stay. Conclusion: P.falciparum has been considered malignant malaria, P.vivax malaria particularly with thrombocytopenia has increased in incidence and is not considered benign any longer.