ICMR-National Institute of Malaria Research, Sector 8, Dwarka, New Delhi 110077, India.
ICMR-National Institute of Malaria Research, Sector 8, Dwarka, New Delhi 110077, India.
J Infect. 2021 Jun;82(6):231-246. doi: 10.1016/j.jinf.2021.03.028. Epub 2021 Apr 5.
A systematic review and meta-analysis (SR-MA) of the available Indian literature on severe vivax malaria (SVM) was undertaken.
Relevant studies in eight electronic databases were retrieved and reviewed. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. The methodological quality of the studies included in the MA was assessed.
Overall, 162 studies were included in the work. The pooled proportion of SVM was 29.3%. The main severity signs/symptoms seen in SVM were jaundice, severe thrombocytopenia (ST), multi-organ dysfunction, and severe anaemia with pooled proportion of 37.4%, 37.2%, 24.2% and 20.4%, respectively. P. falciparum was inducing 6% less ST (RR = 0.94, 95% CI 0.5-1.5, I = 77.87%), 10% less thrombocytopenia (RR = 0.9, 95% CI 0.7-1.1, I = 91.68%) and 20% less DIC (RR = 0.8, 95% CI 0.3-1.9, I = 0%) than P. vivax. An atypical condition like myocarditis, was most commonly observed among the studied SVM cases. The mortality rate in SVM cases ranged from 0 to 12.9% among hospital patients with P. vivax mono-infections.
The present SR-MA provides evidence for P. vivax as the etiologic agent of severe malaria leading to deaths in few cases as seen recently in India. However, research gaps outlined here emphasise the need for further studies on SVM in pregnancy, SVM in drug resistance and correlations with cytoadherence in disease severity due to P. vivax.
对印度有关严重间日疟（SVM）的现有文献进行系统评价和荟萃分析（SR-MA）。
检索并回顾了八个电子数据库中的相关研究。遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。评估了纳入 MA 的研究的方法学质量。
总体而言，共有 162 项研究纳入本研究。SVM 的合并比例为 29.3%。SVM 主要的严重体征/症状是黄疸、严重血小板减少症（ST）、多器官功能障碍和严重贫血，其合并比例分别为 37.4%、37.2%、24.2%和 20.4%。间日疟原虫导致 ST 减少 6%（RR=0.94，95%CI 0.5-1.5，I=77.87%）、血小板减少减少 10%（RR=0.9，95%CI 0.7-1.1，I=91.68%）和 DIC 减少 20%（RR=0.8，95%CI 0.3-1.9，I=0%）。心肌炎等非典型疾病是研究中观察到的 SVM 病例中最常见的。间日疟原虫单一感染的住院患者中，SVM 病例的死亡率范围为 0%至 12.9%。
本 SR-MA 提供了证据表明间日疟原虫是引起严重疟疾的病原体，导致印度近期少数病例死亡。然而，这里概述的研究空白强调了需要进一步研究妊娠期间的 SVM、耐药性 SVM 以及与疾病严重程度相关的细胞黏附之间的关系。
