Clinical spectrum and treatment outcome of severe malaria caused by Plasmodium vivax in 18 children from northern India

Abstract

Objective: The study was intended to document the clinical profile and treatment outcome of severe malaria caused by Plasmodium vivax (P.vivax) in children hospitalized in a tertiary care centre of northern India.

Methods: This prospective observational study was performed among children admitted with severe malaria at a tertiary care referral hospital of northern India from January 2012 to December 2012. Information was recorded pertaining to clinical symptoms at presentation, examination findings, biochemical and hematological investigation, and treatment outcome. Presence of malarial parasite on thick and thin smears and/or positive parasite lactate dehydrogenase (p-LDH) based rapid malaria antigen test was considered diagnostic of 'malaria'. Based on the etiology, children were categorized into three groups: P.vivax, Plasmodium falciparum (P. falciparum) and mixed infection. Children diagnosed with 'severe malaria' (World Health Organization, 2000), were started on intravenous artesunate followed by artemether-lumefantrine combination.

Results: Thirty-five children with a diagnosis of severe malaria were enrolled [18 (51·4%) P. vivax, nine (25·7%) mixed infection, eight (22·8%) P. falciparum]. Clinical features of severe vivax malaria (n = 18) were abnormal sensorium [9 (50%)], multiple seizures [8 (44·4%)], jaundice [5 (27·8%)], severe anaemia [5 (27·8%)], and shock [3 (16·7%)]. Two children [2/18 (11·1%)] infected with P. vivax had died of cerebral malaria, acute respiratory distress syndrome, shock, and metabolic acidosis. The clinical presentation and outcome of severe vivax malaria was found to be similar to severe malaria caused by P. falciparum and mixed infection, except for higher chances of severe anaemia among the children infected with P. falciparum (P = 0·04).

Conclusion: The present study highlights P. vivax as an increasingly recognized causative agent for severe malaria in children from Rohtak, with similar clinical presentation and outcome to that caused by P. falciparum.

Figure 1

Flow diagram of patients screened for malaria among the admitted febrile patients.