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ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 2  |  Page : 134-136

Study of malignant syndromes of Plasmodium vivax


Department of General Medicine, Chalmeda Anand Rao Institute of Medical Sciences (CAIMS), Karimnagar, Telangana, India

Date of Web Publication6-Jun-2018

Correspondence Address:
Dr. Pantam Narayana
Department of General Medicine, Chalmeda Anand Rao Institute of Medical Sciences (CAIMS), Karimnagar, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.233842

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  Abstract 


Introduction: Malaria is one of the major public health problems of our country. Factors responsible for reemergence of malaria in India are emergence and spread of drug-resistant strains across the country coupled with a steady rise in insecticide resistance of vector mosquitoes.
Materials and Methods: In this study, a total of 100 patients were diagnosed to be positive for Plasmodium vivax infection through a rapid diagnostic test, which was confirmed by peripheral smear from August 2015 to October 2015. All the cases were studied for the complications that can be seen with P. vivax malaria.
Results: In this study of 100 patients positive for vivax malaria, approximately 72 had complications such as thrombocytopenia, anemia, pancytopenia, jaundice, respiratory distress, renal failure, and cerebral malaria. Out of the 72 patients, 70 improved with no complications, but two patients died.
Conclusion: Complications with vivax malaria are on the rise, and hence vivax malaria should not be neglected.

Keywords: Complications, Plasmodium vivax, complications


How to cite this article:
Chalmeda N, Narayana P. Study of malignant syndromes of Plasmodium vivax. J NTR Univ Health Sci 2018;7:134-6

How to cite this URL:
Chalmeda N, Narayana P. Study of malignant syndromes of Plasmodium vivax. J NTR Univ Health Sci [serial online] 2018 [cited 2019 Dec 9];7:134-6. Available from: http://www.jdrntruhs.org/text.asp?2018/7/2/134/233842




  Introduction Top


“Malignant tertian” and “benign tertian” are terms that have long been used for two of the major diseases we recognize as malaria.[1] The former is generally considered to be synonymous with Plasmodium falciparum and the latter with P. vivax infection.[1] As the terms “malignant” and “benign” suggest the current dogma that P. falciparum[3] can be severe and life threatening whereas P. vivax tends to be mild.[4] However, there is an observation that there are similar rates and outcomes of severe malaria due to P. vivax also.[5],[6],[7] The various complications seen with P. vivax malaria are thrombocytopenia, anemia, pancytopenia, jaundice, respiratory distress, renal failure, and cerebral malaria.[8],[9],[10] The diagnostic test that was used to diagnose malaria included rapid diagnostic test (card method), which was confirmed by peripheral smear.


  Materials and Methods Top


Every year there are many malaria patients who present to our hospital, with maximum incidence from the months of August to October.

Study design and patient selection

This was a hospital-based study of patients admitted with vivax malaria at our hospital. A study was conducted in the Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar from August 2015 to October 2015. The suspected clinical diagnosis was made on the basis of tertian fever along with other constitutional symptoms. The patients tested positive on rapid diagnostic test and peripheral smear.

Ethical clearance was obtained prior to the study, and written and informed consent was obtained from participating patients or their families.

Patients were asked about their demographic data such as such as age, gender, and occupation. History of similar complaints in the past as well as current treatment were noted. Patients were subjected to a thorough physical examination.

Inclusion criteria

  1. All the P. vivax cases were noted
  2. The age of the patients included in the study was above 15 years.


Exclusion criteria

  1. All the cases that were positive for P. falciparum, P. ovale, dengue fever, and Leptospira were excluded
  2. Patients below 15 years of age were excluded.



  Results Top


There were a total of 100 cases, out of which 72 had varied manifestations. Approximately 35 had thrombocytopenia; 9 had acute kidney injury which reverted after treating the infection. Seven patients presented with pancytopenia which also reverted after treating the infection. Five patients presented with neurological manifestations, out of which 4 were cerebral malaria and 1 presented with seizures. Thirteen presented with hepatopathy. They mainly presented with icterus and/or altered liver function tests. Three presented with hepatorenal syndrome out of which only 1 survived. Only 1 patient presented with acute respiratory distress syndrome.


  Discussion Top


The benign character formerly attributed to P. vivax infection has been dismantled by the increasing number of reports of severe disease associated with infection with this parasite,[10],[11] prompting the need for more thorough and comprehensive characterization of the spectrum of the resulting clinical complications. Endemic areas exhibit wide variations regarding severe disease frequency.[12]

The diverse range and rate of occurrence of clinical complications associated to P. vivax infection widely differ according to reports from different endemic regions,[13],[14] suggesting that many unaccounted factors, including those related to the parasite, the host, or the context in which the infection is produced may interact in causing the clinical presentation.

Unusual manifestations of P. vivax malaria presenting most commonly is with thrombocytopenia [15-17] followed by hepatopathy, renal failure, and pancytopenia. Neurological manifestations in the form of cerebral malaria is also seen with vivax malaria.

Severe malaria is associated with high morbidity and mortality. There is activation and elaboration of cytokine-like interleukin 1, 2, 6, and tumor necrosis factor (TNF) alpha by T helper cells, which promote activation of macrophages resulting in the phagocytosis of blood cells.[18],[19] These cytokines cause sequestration and rapid destruction of the formed blood cells and also depress proliferation of progenitor cells.[20] The high levels of cytokines have been reported to resolve soon after the successful treatment of malaria.


  Conclusions Top


This study has provided robust evidence asserting the role of P. vivax as a cause of severe human disease and death. Indeed, this infection commonly progresses with severe manifestations,[21],[22] and the development of severe symptomatology seems to be more frequent among females, individuals presenting with their first malarial infection, and those with acute or chronic comorbidities.[7] Although the overall fatality rates of P. vivax are on the rise, we observed differences in specific disease manifestations and outcomes,[23] which still require further and more comprehensive studies to better elucidate the mechanisms and factors influencing disease expression.[24] Only by understanding the underlying pathophysiological mechanisms by which this species initiates and modifies organ functions, ultimately leading to clinical disease, as well as the role of the socioeconomic and health systems, will we be able to start answering the many unanswered questions related to this never-to-be-called-again benign parasite.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Abstract
Introduction
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