Acute respiratory distress syndrome in Vivax malaria in children

Amitesh Yadav, Yashwant Kumar Rao, Tanu Midha, Sunisha Arora


Background: Malaria, the most important protozoal disease in humans remains the significant health problem globally. The objective of this study was to study the acute respiratory distress syndrome in children in vivax malaria.

Methods: This prospective study enrolled children with acute febrile illness aged 1-15 years who diagnosed as malaria. Then we searched the children who present with acute (<7 days) history of respiratory distress and fulfill the ARDS criteria.

Results: Among 112 children, enrolled in the study 70 (62.5%) were vivax malaria and 42 (37.5%) were falciparum malaria.21 children were diagnosed as ARDS (The level of PaO2/FiO2 was <200). 42.9% children had ARDS due to vivax and 57.1% due to falciparum. The p-value of 0.039 was obtained denoting a significant association. It was noted that the percentage of vivax and falciparum causing ARDS was comparable. Thus, it showed there is a rising propensity of vivax to cause respiratory failure.

Conclusions: ARDS is an important severe complication of malaria. Previously it was noted mainly with falciparum but now days there is rising propensity of vivax to cause respiratory failure. ARDS in malaria has high mortality so early diagnosis and appropriate treatment with antimalarial drugs can be lifesaving.


Acute respiratory distress, Acute lung injury, Falciparum, Malaria, Vivax

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WHO. World Health Organization Roll Back Malaria Department and United Nations Children’s Fund. World malaria report 2005. Available at 2005.htm. Accessed 2nd October 2006.

WHO. World Health Organization Malaria: Disease Burden in SEA Region. 2009. Available at Accessed October 15, 2009.

Filler S, Causer LM, Newman RD, Barber AM, Roberts JM, MacArthur J, et al. Malaria surveillance--United States, 2001. MMWR Surveill Summ. 2003;52(5):1-14.

Price RN, Tjitra E, Guerra CA, Yeung S, White NJ, Anstey NM. Vivax malaria: neglected and not benign. Am J Trop Med Hyg. 2007;77:79.

Prakash J, Singh AK, Kumar NS, Saxena RK. Acute respiratory distress syndrome in Plasmodium vivax malaria. J Assoc Phy India. 2003;51:265-7.

Wheeler AP, Bernard GR. Acute lung injury and the acute respiratory distress syndrome: a clinical review. Lancet. 2007;369:1553-64.

Agarwal R, Nath A, Gupta D. Non-invasive ventilation in Plasmodium vivax related ALI/ARDS. Intern Med. 2007;46:2007-11.

Price L, Planche T, Rayner C, Krishna S. Acute respiratory distress syndrome in Plasmodium vivax malaria: case report and review of the literature. Trans R Soc Trop Med Hyg. 2007;101:655-9.

Kumar S, Melzer M, Dodds P, Watson J, Ord R. P. vivax malaria complicated by shock and ARDS. Scand J Infect Dis. 2007;39:255-6.

Lomar AV, Vidal JE, Lomar FP, Barbas CV, de Matos GJ, Boulos M. Acute respiratory distress syndrome due to vivax malaria: case report and literature review. Braz J Infect Dis. 2005;9:425-30.

Dzeing-Ella A, NzeObiang PC, Tchoua R, Planche T, BĂ©atriceMboza. Severe falciparum malaria in Gabonese children: clinical and laboratory features Malar J. 2005;4:1

Kochar DK, Tanwar GS, Khatri PC, Kochar SK, Sengar GS, Gupta A, et al. Clinical features of children hospitalized with malaria: a study from Bikaner, Northwest India. Am J Trop Med Hyg. 2010;83:981-9.

Bhave SY, Joshi SV, Warad V, Dhar HL. Hepatic and renal dysfunction in childhood malaria. BHJ. 2005;47:225.

Patwari A, Aneja S, Berry AM, Ghosh S. Hepatic dysfunction in childhood malaria. Arch Dis Child. 1979;54:139-41.

Tripathy R, Parida S, Das L, Mishra DP, Tripathy D, Das MC, et al. Clinical manifestations and predictors of severe malaria in Indian children. Pediatr. 2007;120:e454-60.

Murphy SC, Breman JG. Gaps in the childhood malaria burden in Africa: cerebral malaria, anemia, respiratory distress, and hypoglycemia. Am J Trop Med Hyg. 2001;64:57-67.

Marsh K, Forster D, Waruiru C, Mwangi I, Winstanley M, Marsh V, et al. Indicators of life-threatening malaria in African children. N Engl J Med. 1995;332:1399-404.

Lackritz EM, Campbell CC, Ruebush TK, Hightower AW, Wakube W, Steketee RW, et al. Effect of blood transfusion on survival among children in a Kenyan hospital. Lancet. 1992;340:524-8.

Anstey NM, Handojo T, Pain MC, Kenangalem E, Tjitra E. Lung injury in vivax malaria: pathophysiological evidence for pulmonary vascular sequestration and posttreatment alveolar-capillary inflammation. J Infect Dis. 2007;195:589-96.