Kochar D K, Das Ashis, Kochar Abhishek, Middha Sheetal, Acharya Jyoti, Tanwar G S, Pakalapati Deepak, Subudhi A K, Boopathi P A, Garg Shilpi, Kochar S K
Department of Medicine, RUHS College of Medical Sciences, Jaipur, India.
J Vector Borne Dis. 2014 Sep;51(3):200-10.
BACKGROUND & OBJECTIVES: Description of severe vivax malaria and mixed species infection requires good clinical study. The present study was undertaken to evalute the characteristics of severe malaria patients in Bikaner, northwest India.
This prospective study included 539 admitted adult patients of severe malaria (Plasmodium falciparum 274, P. vivax 221, and mixed infection of Pv + Pf 44). The diagnosis was confirmed by polymerase chain reaction. The categorization of severe malaria was done strictly as per WHO criteria.
The distribution of severe manifestation was similar in severe vivax, falciparum and mixed infections except more cases of thrombocytopenia in P. vivax (p=0.030) and in mixed infection (p=0.004). The risk of developing severe malaria was greatest in patients of mixed infection [53.01% (44/83)] in comparison to Plasmodium falciparum malaria [49.37% (274/555), RR= 1.135; p=0.616] and P. vivax malaria [45.38% (221/ 487), RR = 1.299, p=0.243]. Hepatic dysfunction was the commonest pernicious syndrome [P. falciparum 50% (137/274), P. vivax 43.89% (97/221), and mixed infections 54.55% (24/44)]. Multiorgan dysfunction was present in 40.26% (217/539) patients, the risk was greatest in mixed infection [90.90% (40/44)] in comparison to P. falciparum monoinfection [37.59% (103/274), RR = 12.238; p=0.0001] or P. vivax monoinfection [33.48% (74/ 221), RR = 13.25; p=0.0001]. The risk of mortality in severe malaria was 6.31% (34/539) in which mixed infection had greater risk [9.09% (4/44)] in comparison to P. falciparum [7.30% (20/274); OR = 1.270 (CI 0.347-4.217); p=0.757] or P. vivax [4.52% (10/221); 0R 2.110 (CI 0.527-7.826); p=0.260].
INTERPRETATION & CONCLUSION: Severe vivax or falciparum malaria had almost similar features and prognosis including mortality. Risk of developing severe malaria, multiorgan dysfunction and mortality was more in patients of mixed infection in comparison to P. falciparum or P. vivax monoinfection. A multicentric study on larger number of patients requires further confirmation.
对重症间日疟和混合感染的描述需要良好的临床研究。本研究旨在评估印度西北部比卡内尔重症疟疾患者的特征。
这项前瞻性研究纳入了539例入院的重症疟疾成年患者（恶性疟原虫274例、间日疟原虫221例、间日疟原虫与恶性疟原虫混合感染44例）。诊断通过聚合酶链反应得以证实。重症疟疾的分类严格按照世界卫生组织标准进行。
重症间日疟、恶性疟及混合感染中严重表现的分布相似，但间日疟（p = 0.030）及混合感染（p = 0.004）中血小板减少的病例更多。与恶性疟原虫疟疾[49.37%（274/555），RR = 1.135；p = 0.616]和间日疟原虫疟疾[45.38%（221/487），RR = 1.299，p = 0.243]相比，混合感染患者发生重症疟疾的风险最高[53.01%（44/83）]。肝功能障碍是最常见的凶险综合征[恶性疟原虫50%（137/274）、间日疟原虫43.89%（97/221）、混合感染54.55%（24/44）]。40.26%（217/539）的患者存在多器官功能障碍，与恶性疟原虫单一感染[37.59%（103/274），RR = 12.238；p = 0.0001]或间日疟原虫单一感染[33.48%（74/221），RR = 13.25；p = 0.0001]相比，混合感染的风险最高[90.90%（40/44）]。重症疟疾的死亡率为6.31%（34/539），其中混合感染的风险更高[9.09%（4/44）]，相比之下恶性疟原虫感染为[7.30%（20/274）；OR = 1.270（CI 0.347 - 4.217）；p = 0.757]，间日疟原虫感染为[4.52%（10/221）；OR 2.110（CI 0.527 - 7.826）；p = 0.260]。
重症间日疟或恶性疟具有几乎相似的特征及预后，包括死亡率。与恶性疟原虫或间日疟原虫单一感染相比，混合感染患者发生重症疟疾、多器官功能障碍及死亡的风险更高。需要更多患者参与的多中心研究进行进一步证实。
