Bhattacharjee Prasun, Dubey Suparna, Gupta Vijay Kumar, Agarwal Prerana, Mahato Mathura Prasad
Assistant Professor, Department of Paediatrics.
J Clin Diagn Res. 2013 May;7(5):861-7. doi: 10.7860/JCDR/2013/5652.2960. Epub 2013 Mar 25.
Today, India faces increasing morbidity and mortality due to malaria, which is a global health burden. Plasmodium vivax which was once considered to have a benign course, is now being increasingly associated with complicated malaria. Studies which have been done on the increasing virulence of P. Vivax in children, are exceptionally rare.
This study has addressed some of the hitherto unanswered questions, such as: This study has tried to explore the wide spectrum of severe illnesses which are associated with P.vivax malaria in children.Other co-morbid conditions, which include a co-infection with P.falciparum, have been excluded with great care, to assess the increased virulence of P. Vivax.The present study was focused on the paediatric population with a large sample size of 168 subjects.
This was an observational retrospective analysis on the clinicopathologic manifestations of the paediatric cases which were admitted with severe malaria due to a mono-infection with Plasmodium vivax, in a tertiary-care centre in the national capital region, India.
The diagnosis of the mono-infection with P. Vivax malaria was established by making peripheral blood films (PBFs) and by doing rapid diagnostic tests. The severe forms of malaria were categorized as per the World Health Organization guidelines and the clinical and laboratory findings in these cases of complicated malaria were studied.
A descriptive statistical analysis was done by using the SPSS software and an Excel worksheet.
This comprehensive study revealed a multisystem involvement. Abdominal manifestations were observed in 75(45.8%) cases (which included hepatosplenomegaly, hepatomegaly, splenomegaly and ascites) and hepatic dysfunction and jaundice were observed in 28(16.7%) cases. The haematological tests showed moderate to severe anaemia in 151(89.9%) cases and thrombocytopaenia in 138(82.1%) cases. Petechiae were noted in 45(26.8%) cases and a gross bleeding was noted in 9(5.3%) cases. The respiratory findings which included tachypnoea, pleural effusions and ARDS were observed in 22(13.1%) cases. Renal dysfunction was noted clinically in 20(11.9%) cases and biochemically in 16(9.5%) cases. Shock was observed in 7(4.1%) cases, cerebral malaria was observed in 10(5.9%) cases and hypoglycaemia was observed in 5(3%) cases. Multi-organ dysfunction was detected in 11(6.54%) cases. The complications were more severe in the younger children (0-5 years).
A mono-infection with P. Vivax may lead to severe malaria and this increased virulence has resulted in the changing picture of P. Vivax malaria, leading to a spectrum of complications which are similar to those which are traditionally associated with P. Falciparum.
如今，印度因疟疾面临着日益增加的发病率和死亡率，疟疾是一项全球健康负担。间日疟原虫曾被认为病程良性，如今却越来越多地与复杂型疟疾相关联。针对儿童中间日疟原虫毒力增强所开展的研究极为罕见。
本研究解决了一些迄今未得到解答的问题，比如：本研究试图探究与儿童间日疟原虫疟疾相关的广泛严重疾病谱。已极为谨慎地排除了其他合并症，包括与恶性疟原虫的合并感染，以评估间日疟原虫的毒力增强情况。本研究聚焦于儿科人群，样本量达168名受试者。
这是一项针对印度国家首都地区一家三级医疗中心收治的因间日疟原虫单一感染导致严重疟疾的儿科病例临床病理表现的观察性回顾分析。
通过制作外周血涂片（PBF）和进行快速诊断检测来确诊间日疟原虫单一感染。根据世界卫生组织指南对严重型疟疾进行分类，并研究这些复杂型疟疾病例的临床和实验室检查结果。
使用SPSS软件和Excel工作表进行描述性统计分析。
这项全面研究揭示了多系统受累情况。75例（45.8%）出现腹部表现（包括肝脾肿大、肝肿大、脾肿大和腹水），28例（16.7%）出现肝功能障碍和黄疸。血液学检查显示151例（89.9%）有中度至重度贫血，138例（82.1%）有血小板减少。45例（26.8%）出现瘀点，9例（5.3%）出现大出血。22例（13.1%）出现呼吸方面的表现，包括呼吸急促、胸腔积液和急性呼吸窘迫综合征（ARDS）。临床上20例（11.9%）出现肾功能障碍，生化检查中16例（9.5%）出现肾功能障碍。7例（4.1%）出现休克，10例（5.9%）出现脑型疟疾，5例（3%）出现低血糖。11例（6.54%）检测到多器官功能障碍。并发症在年幼儿童（0 - 5岁）中更为严重。
间日疟原虫单一感染可能导致严重疟疾，这种毒力增强导致了间日疟原虫疟疾情况的改变，引发了一系列与传统上与恶性疟原虫相关的并发症类似的并发症。
