IJCCR 2013, Vol.3, No.2, 7
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Table 4 Types of severe vivax malaria (n=60)
Number (%)
Single complication
Haematological (H)
20 (33.3%)
Jaundice (J)
17 (28.3%)
Cerebral malaria (CM)
7 (11.6%)
Respiratory distress (RD)
2 (3.3%)
Total
46 (76.7%)
Multiple complications
CM+J+renal failure (RF)
4 (6.6%)
J+H
4(6.6%)
J+RF
3 (5.0%)
CM+RD
3 (5.0%)
Total
14 (23.3%)
test. Out of 300 cases of Pv malaria 270 (90.0%) were
diagnosed from PBS and rest 30 (10.0%) were diagno-
sed by ICT test. The mean parasitic count was 4300.7
¡
À 180.5/µL in UVM and 8756.3 ¡À 256.3/µL in SVM.
The mean gametocyte count was 155.5 ¡À 15.5/µL in
UVM and 170.8 ¡À13.9/µL in SVM (Table 3).
The mean interval of onset of fever to hospitalization
is 3.2 ¡À 1.3 and 6.8 ¡À 2.8 days in UVM and SVM
respectively. Patients of UVM used to seek treatment
approximately 2 times earlier than SVM (
p
<0.05).
Inappropriate and inadequate antimalarial drug was
given to 68.3% (41of 60) patients of SVM compared
to 33.3% (80 of 240) of UVM (
p
<0.001). Low BMI
(
<20) was found in 42 (70.0%) cases of SVM
compared to 80(33.3%) in UVM (
p
<0.001). Associat-
ed infection was found in 35 (70.0%) cases of SVM
that included Urinary tract infection, URTI, Pneumon-
ia, and Enteric fever in 18 (51.4%), 7 (20.0%), 6
(17.5%),
and 4 (11.4%) cases respectively. Co-morbi-
dity was found in 15 (25.0%) cases of SVM.
There were 7 independent risk factors for develop-
ment of SVM. They were 1) Low BMI<20.0 (OR=
1.9[95%
CI 1.2-3.1], p=0.002), 2) High parasite count
>8 000/µL (OR=1.8 [95%CI=1.1-2.8], p=0.01), 3)
Age more than 40 years (OR=4.4[95%CI=1.4-14.3],
p=0.02), 4) Fever to treatment interval>4.0 days
OR=3.2 [95%CI=2.4-7.3], p=0.002), 5) Bad treatment
history OR=3.6 [95%CI=2.4-7.3], p=0.002), 6)
Associated infection OR=4.2 [95%CI=3.4-7.3],
p=0.002), 7) co-morbid condition OR=3.8 [95%CI=
2.8-5.3],
p=0.001. Single risk factor was present in 11
(18.3%)
cases and multiple risk factors was present in
rest 49 (81.7 %) cases. 2, 3, and 4 risk factors were
present in 25 (41.6%), 15 (25.0%), and 9 (15.0%)
cases respectively.
The occurrence of vivax malaria (both for SVM and
UVM) was more frequent (63.3%, 190 of 300) in
rainy season i.e. from June to September than dry
season (26.7%, 110 of 300, p<0.01). During rainy
season total number of SVM and UVM were 40
(66.6%)
and 150 (62.5%) and in dry seasons it was 20
(33.3%)
and 90 (37.5%) respectively (p<0.01).
1.2
Sub-study
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2
During sub-study
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2
period 60 patients of SVM were
treated with inj. artesunate. Adequate clinical and
parasitological response was found in 58 (96.6%)
cases. Early treatment failure was not found. One
patient (1.6%) developed ARDS during the treatment.
Therefore, it is considered as late treatment failure.
Late parasitological failure was found in 1 (1.6%)
patient.
In addition to inj. Artesunate, appropriate antibiotic
was administered according to culture and sensitivity
and before the report, inj. Ceftriaxone 1 gm IV was
started empirically in patients with evidence of
infection. Dialysis was done in 2 (33.3%) patients. 2
(33.3%)
patients of severe anaemia received packed
cell transfusion and 1 (1.6%) patient of thrombocytop-
enia with bleeding received one unit of platelet
transfusion. Patients with convulsion were treated
with inj. Phenytoin sodium. Mefloquine was adminis-
tered along with Inj. Artesunate as a component of
ACT. We did not encounter any adverse drug reaction
during the treatment.
With treatment, the fever resolution time and parasitic
clearance time was 48.2±25.6 hours and 48.2±25.6
hours respectively. The recovery time of different
organ dysfunctions were given in Table 5.
Table 5 Recovery of severe vivax malaria
Parameters
Recovery
Fever resolution time (hours)
47.8
±24.8
Parasitic clearance time (hours)
48.2
±25.6
Coma recovery time (days)
3.5
±1.2
Jaundice recovery time (days)
6.5
±2.5
Anaemia recovery time (days)
36.6
±14.6
Platelet recovery time (days)
4.2
±2.6
Resp. recovery time (days)
4.4
±1.2
Renal failure recovery time (days)
8.2
±3.8