Clinical profile of severe Plasmodium vivax malaria in a tertiary care centre in Mumbai from June 2010-January 2011.

Background: Plasmodium vivax is the most widely distributed human malaria parasite with an at risk population of 2.5 billion persons. With the implementation of molecular diagnosis, it has become evident that P. vivax monoinfection could also result in multiple organ dysfunction and severe life-threatening disease as seen in P. falciparum infection.

Aims And Objectives: To note the clinical profile of patients with severe vivax malaria with regards to demographic, clinical and biochemical profile and its outcome. To compare the profile of falciparum malaria with vivax malaria.

Method And Material: We recruited 711 patients fulfilling the criteria for severe malaria during the study period from June 2010 to Jan 2011. Detailed history and examination findings were noted in all the patients. All the patients were subjected to routine haematological and biochemical investigations. The end points were discharge from wards or death due to malaria.

Results: We had 711 patients with severe malaria of which 488 (68.53%) patients had severe vivax and 223 (31.32%) had severe falciparum malaria. Amongst vivax group, 351 (71.92%) were males and 137 (28.07%) females. Thrombocytopenia (89.13%) was the most common complication followed by renal (31.96%), hepatic (19.46%) cerebral (8.19%) and pulmonary (1.63%) involvement. Most patients were in the age group of 21-30 years and mortality increased with increasing age. The mortality observed in severe vivax malaria was 9.01% (44/488), as compared to falciparum malaria where it was 16.14% (80/223).

Conclusions: Severe vivax malaria is now very common with increasing mortality. The mortality in vivax malaria increases with increasing age. Thrombocytopenia is very common in severe vivax infection. Also, renal, hepatic, lung and cerebral involvement are also occur with increasing frequency. Along with age, severe metabolic acidosis is an independent risk factor for fatal outcome.