Unusual presentation of Plasmodium vivax: a neglected human malaria parasite

• Published in: Parasitology research (1987) 2012-06, Vol.110 (6), p.2573-2576
• Main Authors: Kute, Vivek B., Goswami, Jitendra G., Vanikar, Aruna V., Shah, Pankaj R., Gumber, Manoj R., Patel, Himanshu V., Kanodia, Kamal V., Trivedi, Hargovind L.
• Format: Article
• Language: English
• Subjects: Adolescent; Antimalarials - administration & dosage; Benign; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Case reports; Deformability; Development and progression; Edema; Erythrocytes; Female; Fundamental and applied biological sciences. Psychology; General aspects; General aspects and techniques. Study of several systematic groups. Models; Health aspects; Hemodialysis; Host-parasite relationships; Human protozoal diseases; Humans; Hypoglycemia; Hyponatremia; Immunology; Infectious diseases; Invertebrates; Jaundice; Malaria; Malaria, Vivax - diagnosis; Malaria, Vivax - drug therapy; Malaria, Vivax - parasitology; Malaria, Vivax - pathology; Medical Microbiology; Medical sciences; Microbiology; Microscopy; Neglected Diseases - diagnosis; Neglected Diseases - drug therapy; Neglected Diseases - parasitology; Neglected Diseases - pathology; Parasitemia - diagnosis; Parasitic diseases; Peripheral blood; Physiological aspects; Plasmodium; Plasmodium falciparum; Plasmodium vivax; Plasmodium vivax - isolation & purification; Protozoal diseases; Short Communication; Thrombocytopenia; Treatment Outcome
• ISSN: 0932-0113; 1432-1955
• DOI: 10.1007/s00436-011-2776-7

Severe and complicated malaria is usually caused by Plasmodium falciparum malaria (PF ) but it has been increasingly observed that Plasmodium vivax malaria (PV), which was otherwise considered to be benign malaria, with a low case–fatality ratio, can also occasionally result in severe disease as with PF malaria. There is an urgent need to re-examine the clinical spectrum and burden of PV so that adequate control measures can be implemented against this emerging but neglected disease. We report a case of severe PV malaria with multi-organ dysfunction. Patients exhibited acute kidney injury, severe anemia/thrombocytopenia, jaundice, hypoglycemia, hyponatremia, and pulmonary edema. Peripheral blood microscopy by trained and expert pathologist and rapid diagnostic test showed the presence of PV and absence of PF. The patient recovered completely with anti-malarial drugs, supportive measures, and hemodialysis.Recent microrheologic research that analyzed malaria severity in PV clearly demonstrated enhanced aggregation, erythrocyte clumping, and reduced deformability affecting microcirculation. Our case report highlights the fact that PV malaria is benign by name but not always by nature. PV can lead to unusual and potentially life-threatening complications. Further large-scale multi-centric studies are needed to define this less known entity.