Kumar Rishikesh, Saravu Kavitha
a Department of Medicine, Kasturba Medical College , Manipal University , Manipal , India.
b Manipal McGill Center for Infectious Diseases (MAC-ID) , Manipal University , Manipal , India.
Pathog Glob Health. 2017 May;111(3):148-160. doi: 10.1080/20477724.2017.1309342. Epub 2017 Apr 3.
Plasmodium vivax is recognized to cause severe malaria and mortality. We aimed to determine the proportion of disease severity, the spectrum of complications, underlying non-infectious comorbidities and predictors of severity in monoinfection P. vivax malaria among adults at a tertiary healthcare centre in Southwestern India. A prospective cohort study was conducted among microscopically confirmed monoinfection P. vivax acute malaria patients aged, ≥18 years. Cases with pregnancy and concomitant febrile illnesses including mixed malaria were excluded. Cases were distinguished as either 'severe' or 'non-severe' P. vivax malaria as per the definitions laid by the World Health Organization. Of total 511 acute P. vivax cases studied, 23.9% (122/511) had severe malaria. The proportion of severity did not vary between microscopy alone and additional nPCR proved monoinfection P. vivax subgroups. There was no significant difference (p = 0.296) in the occurrence of non-infectious comorbidities among non-severe (9.0%, 35/389) and severe (12.3%, 15/122) vivax groups. Multiple complications despite early parasite clearance resulted in delayed casualty in two cases, indicating overall case fatality rate of 3/1000 cases. Age >40 years, rising respiratory rate, total bilirubin, serum creatinine and falling hemoglobin were the independent predictors of disease severity in this vivax malaria cohort. Total and direct bilirubin and serum urea had good discriminatory performance for severe vivax malaria. Total bilirubin should be considered as an important prognostic marker while managing P. vivax malaria. Patients with multiple complications must be treated cautiously as there may be delayed deterioration leading to mortality despite parasite clearance.
间日疟原虫被认为会导致严重疟疾和死亡。我们旨在确定印度西南部一家三级医疗中心成年单感染间日疟原虫疟疾患者中疾病严重程度的比例、并发症谱、潜在非感染性合并症以及严重程度的预测因素。对年龄≥18岁、经显微镜确诊为单感染间日疟原虫急性疟疾的患者进行了一项前瞻性队列研究。排除妊娠及伴有发热性疾病（包括混合疟疾）的病例。根据世界卫生组织制定的定义，病例被区分为“严重”或“非严重”间日疟原虫疟疾。在总共研究的511例急性间日疟原虫病例中，23.9%（122/511）患有严重疟疾。仅通过显微镜检查和经额外巢式聚合酶链反应（nPCR）证实的单感染间日疟原虫亚组之间，严重程度比例没有差异。在非严重（9.0%，35/389）和严重（12.3%，15/122）间日疟原虫组中，非感染性合并症的发生率没有显著差异（p = 0.296）。尽管寄生虫早期清除，但仍出现多种并发症，导致两例患者死亡延迟，表明总体病死率为3/1000例。年龄>40岁、呼吸频率升高、总胆红素、血清肌酐升高以及血红蛋白降低是该间日疟原虫疟疾队列中疾病严重程度的独立预测因素。总胆红素和直接胆红素以及血清尿素对严重间日疟原虫疟疾具有良好的鉴别性能。在管理间日疟原虫疟疾时，应将总胆红素视为重要的预后标志物。患有多种并发症的患者必须谨慎治疗，因为尽管寄生虫已清除，但可能会出现延迟恶化导致死亡。
