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IJCCR 2013, Vol.3, No.3, 17
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25
17
Research Report Open Access
Severe Vivax Malaria: A Study on its Clinical Manifestations, Risk Factors, Outcome
and Therapeutic Efficacy of Artesunate
Manoj Kumar Mohapatra
Laxmi Kanta Dash
Abhipsa Mohapatra
Dept of Medicine, V.S.S. Medical College, Burla, Sambalpur, Odisha
Qr.No.C/1, Doctors Colony, Burla, Sambalpur, Odisha, 768017
Corresponding author email:
International Journal of Clinical Case Reports 2013, Vol.3, No.3 doi: 10.5376/ijccr.2013.03.0003
Received: 10 Feb., 2012
Accepted: 26 Feb., 2012
Published: 08 Mar., 2012
Copyright: © 2013 Mohapatra et al., This is an open access article published under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article as:
Mohapatra et al., 2013, Severe Vivax Malaria: A Study on its Clinical Manifestations, Risk Factors, Outcome and Therapeutic Efficacy of Artesunate,
International Journal of Clinical Case Reports, Vol.3, No.3 17-25 (doi: 10.5376/ijccr.2013.03.0003)
Abstract
Severe vivax malaria has been emerged as a newly recognised entity in different parts of the globe. This study was
undertaken because there is lack of research on different clinical and therapeutic aspects of the disease. It comprised of two parallel
sub-studies. Sub-study
-
1
evaluated the clinical manifestations, risk factors, and outcome. Sub-study-2 investigated the therapeutic
efficacy of Artesunate.
P. vivax
malaria was diagnosed from Giemsa stained peripheral blood smear and ICT test. Severe malaria was
diagnosed according to WHO criteria. Organ dysfunction was defined and severity of complication was assessed by Malaria Severity
Score. 300 adult patients of vivax malaria were enrolled in the study. Of them 60 (20.0%) had severe malaria. Single and multiple
complication was found in 46 (76.7%) and 14 (23.3%) cases. Jaundice and haematological complication were the most common
complications (n=24, 40.0% each) followed by cerebral complication (n=14, 23.3%). Among the multiple complications, the
constellation of jaundice, cerebral malaria, and renal failure was (6.6%) common. The risk factors for developing severe malaria are
low BMI (<20.0), high parasite count (>8 000/µL), age more than 40 years , fever to treatment interval (>4.0 days), bad treatment
history, associated infection, and co-morbid conditions.
Inj.
artesunate was effective with adequate efficacy in 96.6% cases. The
outcome was good without any death.
P. vivax
malaria can complicate with severe malaria with different risk factors. Artesunate is
effective with good outcome.
Keywords
Severe vivax malaria, Malaria Severity Score, Risk Factors, Co-morbidity
Introduction
Human malaria is caused primarily by 4 different
species of
Plasmodium
namely;
P. falciparum
,
P. vivax
,
P
.
malariae
,
and
P. ovale
.
Of them
P. vivax
(
Pv)
malaria is the second most common cause of malaria
in the globe after
P.
falciparum
(
Pf) malaria
(
.
In South-East Asia region, India alone contributes
80%
of malaria cases and in India malaria is
contributed the most by Odisha state (World Health
Organization, 2000). Both Pf and Pv are common in
this part of India. Unlike falciparum malaria, severe
forms of vivax malaria are uncommon, hence it is
termed as “benign tertian” malaria. However, severe
vivax malaria (SVM) has been described in Europe
and China in the past, which was related to
malnutrition and other concurrent disease (Warrell,
1993).
There were few case reports of severe forms of
vivax malaria till we made a prospective observational
study on
P. vivax
malaria in 2002 from Odisha,
Eastern India that showed about 11.2% of vivax
malaria may present with complications like jaundice,
anaemia, thrombocytopenia, pancytopenia, and
cerebral malaria (Mohapatra et al., 2002). We also
emphasized it as a warning signal and drug resistance
may have a role. Within 10 years of speculation, SVM
was found not only from India but also from other
parts of the globe. From India it is mostly detected
from North, North West, and Western part of India and
outside India, it was reported from PNG, Indonesia,
and Brazil (Kochar et al., 2009; Nadkar et al., 2012;
Limaye et al., 2012; Genton et al., 2008; Tjitra et al.,
2008;
Andrade et al., 2010). In non-immune persons
the symptoms may temporarily incapacitate the
patients without any mortality. There were no deaths
during an epidemic of vivax malaria in Sri Lanka in
the year 1969 in which about half a million people
affected (Warrell, 1993). However, recent reports from
India and other parts of globe showed that vivax
malaria not only manifest as severe form but also can
