Severe Plasmodium vivax Malaria: A Report on Serial Cases from Bikaner in Northwestern India
Severe Plasmodium vivax Malaria: A Report on Serial Cases from Bikaner in Northwestern India
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DOI：
10.4269/ajtmh.2009.80.194
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发表时间：
2009-02-01
影响因子：
3.3
通讯作者：
Gupta, Vikas
中科院分区：
文献类型：
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作者：
Kochar, Dhanpat K.;Das, Ashish;Gupta, Vikas
流行病学研究和严重间日疟原虫疟疾的成人生活在疟疾流行区的临床描述是罕见的，需要更多的关注，以了解动态及其与免疫系统的相互作用。这项观察性研究包括1,091名入住S. P. 2003年9月至2005年12月，印度比卡内尔医学院和相关医院集团。通过外周血膜（PBF）、快速诊断试验（RDT）和聚合酶链反应（PCR）确定了间日疟的诊断，并根据世界卫生组织的指南对重症疟疾进行了分类。在1 091名疟疾患者中，635人患有恶性疟原虫疟疾，456人患有间日疟原虫疟疾。在严重表现的患者中，40例有PBF、RDT和PCR诊断的间日疟单感染证据。观察到的并发症为肝功能障碍和黄疸23例（57.5%），肾功能衰竭18例（45%），重度贫血13例（32.5%），脑型疟疾5例（12.5%），急性呼吸窘迫综合征4例（10%），休克3例（7.5%），低血糖1例（2.5%）。5例（12.5%）患者观察到血小板减少，19例（47.5%）患者检测到多器官功能障碍。需要进一步的大规模多中心流行病学研究来确定这种鲜为人知的实体的基本病理学。
Epidemiologic studies and clinical description of severe Plasmodium vivax malaria in adults living in malaria-endemic areas are rare and more attention is needed to understand the dynamics and its interaction with the immune system. This observational study included 1,091 adult patients admitted to medical wards of S. P. Medical College and associated group of hospitals in Bikaner, India from September 2003 through December 2005. The diagnosis of P vivax malaria was established by peripheral blood film (PBF), rapid diagnostic test (RDT), and polymerase chain reaction (PCR), and severe malaria was categorized as per World Health Organization guidelines. Of 1,091 patients with malaria, 635 had P. falciparum malaria and 456 had P. vivax malaria. Among patients with severe manifestations, 40 had evidence of monoinfection of P vivax malaria diagnosed by PBF, RDT, and PCR. Complications observed were hepatic dysfunction and jaundice in 23 (57.5%) patients, renal failure in 18 (45%) patients, severe anemia in 13 (32.5%) patients, cerebral malaria in 5 patients (12.5%), acute respiratory distress syndrome in 4 patients (10%), shock in 3 patients (7.5%), and hypoglycemia in 1 (2.5%) patient. Thrombocytopenia was observed in 5 (12.5%) patients, and multi-organ dysfunction was detected in 19 (47.5%) patients. Further large-scale multicentric epidemiologic studies are needed to define the basic pathology of this less known entity.