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. 2023 Sep 11;77(5):721-728.
doi: 10.1093/cid/ciad262.

Severe Falciparum and Vivax Malaria on the Thailand-Myanmar Border: A Review of 1503 Cases

Cindy S Chu  1   2 , Marie Stolbrink  1 , Daniel Stolady  1 , Makoto Saito  2   3 , Candy Beau  1 , Kan Choun  1 , Tha Gay Wah  1 , Ne Mu  1 , Klay Htoo  1 , Be Nu  1 , Arunrot Keereevijit  1 , Jacher Wiladpaingern  1 , Verena Carrara  1   2   4 , Aung Pyae Phyo  1 , Khin Maung Lwin  1 , Christine Luxemburger  1 , Stephane Proux  1 , Prakaykaew Charunwatthana  5   6 , Rose McGready  1   2 , Nicholas J White  2   5 , François Nosten  1   2
Affiliations

Severe Falciparum and Vivax Malaria on the Thailand-Myanmar Border: A Review of 1503 Cases

Cindy S Chu et al. Clin Infect Dis. .

Abstract

Background: The northwestern border of Thailand is an area of low seasonal malaria transmission. Until recent successful malaria elimination activities, malaria was a major cause of disease and death. Historically the incidences of symptomatic Plasmodium falciparum and Plasmodium vivax malaria were approximately similar.

Methods: All malaria cases managed in the Shoklo Malaria Research Unit along the Thailand-Myanmar border between 2000 and 2016 were reviewed.

Results: There were 80 841 consultations for symptomatic P. vivax and 94 467 for symptomatic P. falciparum malaria. Overall, 4844 (5.1%) patients with P. falciparum malaria were admitted to field hospitals, of whom 66 died, compared with 278 (0.34%) with P. vivax malaria, of whom 4 died (3 had diagnoses of sepsis, so the contribution of malaria to their fatal outcomes is uncertain). Applying the 2015 World Health Organization severe malaria criteria, 68 of 80 841 P. vivax admissions (0.08%) and 1482 of 94 467 P. falciparum admissions (1.6%) were classified as severe. Overall, patients with P. falciparum malaria were 15 (95% confidence interval, 13.2-16.8) times more likely than those with P. vivax malaria to require hospital admission, 19 (14.6-23.8) times more likely to develop severe malaria, and ≥14 (5.1-38.7) times more likely to die.

Conclusions: In this area, both P. falciparum and P. vivax infections were important causes of hospitalization, but life-threatening P. vivax illness was rare.

Keywords: Plasmodium falciparum; Plasmodium vivax; epidemiology; severe malaria.

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Conflict of interest statement

Potential conflicts of interest. M. Stolbrink reports a Clinical PhD fellowship from Wellcome Trust, unrelated to this manuscript or the topic. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Flow diagram of malaria cases included. Excluded cases are not enclosed in an outlined box. Abbreviations: P. falciparum, P. malariae, P. ovale, and P. vivax, Plasmodium falciparum, malariae, ovale, and vivax; WHO, World Health Organization.
Figure 2.
Figure 2.
The relative risks (RRs) of hospitalization, severe malaria, and death for Plasmodium falciparum compared with Plasmodium vivax. In 3 of the 4 fatalities with P. vivax malaria (white box) the primary diagnosis was sepsis, and the causal role of malaria was uncertain.
See this image and copyright information in PMC

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