IJCCR 2013, Vol.3, No.3, 17
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18
cause death (Kochar et al., 2009; Nadkar et al., 2012;
Limaye et al., 2012).
Further, the treatment of SVM is confusing. It has
been recommended by WHO that SVM should be
treated like severe falciparum malaria. Artesunate has
been considered now as first line treatment for severe
falciparum maIaria (World Health Organization, 2010).
But there is no report regarding the efficacy of
artesunate for treatment of SVM. Therefore, we have
undertaken this research to study the clinical pattern,
risk factors, outcome, and therapeutic efficacy of
artesunate in SVM in a tertiary care centre.
1
Results
1.1
Sub-study-1
During the sub-study
-
1
period 1188 diagnosed
patients of malaria attended the hospital. Of them Pf,
Pv, and mixed Pf & Pv malaria constituted 770
(64.8%), 300 (25.3%),
and 118 (9.9%) respectively.
Among them severe malaria was found in 541 (45.5%)
cases, of which Pf, Pv, and mixed infection constituted
85.0% (
n=460), 11.1% (n=60), and 3.9% (n=21) cases
respectively. The number of severe malaria was
significantly (
p
<0.001) more in Pf than Pv. Out of the
patients of vivax malaria 20.0% (60 of 300) developed
severe malaria. The observations of severe Pv malaria
are presented in this study.
Among the 300 patients of Pv, there were 205 (68.3%)
males and 95 (31.7%) females with a ratio of 2.6:1.
Comparison of age distribution showed that the mean
age of patients with severe malaria was 36.8±11.2
years compared to 28.5±8.5 years (
p
<0.001) of unco-
mplicated vivax malaria. Beyond the age of 40 years,
SVM and UVM was found in 45.0% (n=27) and
29.2% (
n=70) cases respectively (
p
<0.05) (Table 1).
The clinical and baseline data were given in Table 2
and Table 3.
Irrespective of severity, fever was the most common
clinical presentation of vivax malaria (Table 2).
Intermittent fever with typical paroxysm was present
in 277 (92.3%) cases whereas continuous fever was
present in 23 (7.7%) cases. In addition to fever
complaints like head ache, malaise, vomiting,
abdominal pain were found in 196 (65.3%), 158
(52.6%), 152 (50.7%), 83 (27.6%)
respectively.
Organ specific complaints were present in all 60
patients of SVM which is more than UVM (
p
<0.001).
Out of 60 cases of SVM, 46 (76.7%) had single
complication and 14 (23.3%) had multiple complicati-
ons. 24 (40.0%) patients had jaundice of which 17
(70.8%)
as single and 7 (29.2%) as multiple complica-
tions. Hematological abnormality (n=24, 40%) as
single organ dysfunction was found in 20 (83.3%) and
as component of multiple complication in 4 (16.6%)
cases. Of them anaemia, thrombocytopenia, and perip-
heral pancytopenia was found in 24 (100.0%), 11
(45.8%),
and 6 (25.0%) cases respectively. However,
severe anaemia (Hb<6.0 gm/dl) was present in 8
(33.3%)
cases. It is notable that in spite of thrombocy-
topenia bleeding manifestations are uncommon and
found only in 1 (1.7%) case. Neurological involvem-
ent was found in 14 (23.3%) cases. Convulsion was
present in 2 (3.3%) cases of SVM. Respiratory
distress was found in 6 (10.0%) cases of which 2
(33.3%)
with single and 4 (66.6%) as a part of
multiple complications. One patient had ARDS during
treatment. Renal failure was present in 7 (11.7%)
cases and all were as a part of multiple complications.
Renal failure alone as a single organ involvement was
not found in this series (Table 4). The mean malaria
severity score (MSS) of SVM was 6.7 ¡À 2.6.
The diagnosis of malaria was made from peripheral
blood smear and Immuno chromatographic Test (ICT)
Table 1 Age and sex distribution
Severe vivax malaria (SVM)
Uncomplicated vivax malaria (UVM)
Age
Male
Female
Total (%)
Male
Female
Total (%)
15
~20
4
2
6 (10.0)
34
15
49 (20.4)
21
~30
8
4
12 (20.0)
38
17
55 (22.4)
31
~40
10
5
15 (25.0)
44
22
66 (27.5)
41
~50
12
8
20 (33.3)
22
6
28 (11.6)
51
~60
4
2
6 (10.0)
16
10
26 (10.8)
>61
1
0
1 (1.6)
12
4
16 (6.7)
Total
39
21
60
166
74
240