Department of Pediatrics, Pt. B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
Pathog Glob Health. 2013 Jun;107(4):210-4. doi: 10.1179/2047773213Y.0000000096.
The study was intended to document the clinical profile and treatment outcome of severe malaria caused by Plasmodium vivax (P.vivax) in children hospitalized in a tertiary care centre of northern India.
This prospective observational study was performed among children admitted with severe malaria at a tertiary care referral hospital of northern India from January 2012 to December 2012. Information was recorded pertaining to clinical symptoms at presentation, examination findings, biochemical and hematological investigation, and treatment outcome. Presence of malarial parasite on thick and thin smears and/or positive parasite lactate dehydrogenase (p-LDH) based rapid malaria antigen test was considered diagnostic of 'malaria'. Based on the etiology, children were categorized into three groups: P.vivax, Plasmodium falciparum (P. falciparum) and mixed infection. Children diagnosed with 'severe malaria' (World Health Organization, 2000), were started on intravenous artesunate followed by artemether-lumefantrine combination.
Thirty-five children with a diagnosis of severe malaria were enrolled [18 (51·4%) P. vivax, nine (25·7%) mixed infection, eight (22·8%) P. falciparum]. Clinical features of severe vivax malaria (n = 18) were abnormal sensorium [9 (50%)], multiple seizures [8 (44·4%)], jaundice [5 (27·8%)], severe anaemia [5 (27·8%)], and shock [3 (16·7%)]. Two children [2/18 (11·1%)] infected with P. vivax had died of cerebral malaria, acute respiratory distress syndrome, shock, and metabolic acidosis. The clinical presentation and outcome of severe vivax malaria was found to be similar to severe malaria caused by P. falciparum and mixed infection, except for higher chances of severe anaemia among the children infected with P. falciparum (P = 0·04).
The present study highlights P. vivax as an increasingly recognized causative agent for severe malaria in children from Rohtak, with similar clinical presentation and outcome to that caused by P. falciparum.
本研究旨在记录在印度北部一家三级护理中心住院的儿童中由间日疟原虫（P.vivax）引起的重症疟疾的临床特征和治疗结果。
这是一项于 2012 年 1 月至 12 月在印度北部一家三级转诊医院进行的前瞻性观察研究。记录了入院时的临床症状、检查结果、生化和血液学检查以及治疗结果。厚涂片和/或薄涂片上存在疟原虫以及/或基于乳酸脱氢酶（p-LDH）的快速疟疾抗原检测阳性被认为是“疟疾”的诊断依据。根据病因，将儿童分为三组：间日疟原虫、恶性疟原虫（P. falciparum）和混合感染。诊断为“重症疟疾”（世界卫生组织，2000 年）的儿童开始接受静脉注射青蒿琥酯，随后使用青蒿琥酯-甲氟喹联合治疗。
共纳入 35 例重症疟疾患儿[18 例（51.4%）间日疟原虫、9 例（25.7%）混合感染、8 例（22.8%）恶性疟原虫]。18 例重症间日疟原虫的临床特征为意识障碍[9 例（50%）]、多次发作[8 例（44.4%）]、黄疸[5 例（27.8%）]、严重贫血[5 例（27.8%）]和休克[3 例（16.7%）]。2 例（2/18，11.1%）感染间日疟原虫的患儿因脑型疟疾、急性呼吸窘迫综合征、休克和代谢性酸中毒而死亡。重症间日疟原虫疟疾的临床表现和结局与恶性疟原虫和混合感染引起的重症疟疾相似，但感染恶性疟原虫的儿童更有可能发生严重贫血（P = 0.04）。
本研究强调了间日疟原虫作为罗塔克地区儿童重症疟疾日益被认识的病原体，其临床特征和结局与恶性疟原虫相似。
