Unusual manifestations of malaria in children
DOI:
https://doi.org/10.18203/2349-3291.ijcp20211685Keywords:
Malaria, Unusual presentations, Recognition, MortalityAbstract
Background: Till recently, vivax malaria was being regarded as a “benign” disease. Falciparum malaria is known to be a serious illness with life threatening complications as cerebral malaria, jaundice, acute kidney injury, metabolic acidosis and bleeding diatheses. Recently, some other atypical presentations are also being noted which have hardly been discussed previously. The present report highlights the various unusual presentations of malaria in children.
Methods: The study design was hospital based prospective observational study conducted over one year. Children between the ages of 1 month to 18 years admitted with a diagnosis of malaria confirmed by peripheral blood smear examination and/or rapid diagnostic test having unusual manifestations were studied. Patients with dengue fever, enteric fever, viral hepatitis, or any other concomitant infection were excluded. The various unusual manifestations of malaria, disease course and outcome were analysed.
Results: 58 (27.1%) out of 214 patients studied were found to have atypical manifestations. The unusual features observed were ARDS in vivax malaria (n=11), fulminant hepatic failure (n=5), post malaria neurological syndrome (n=3), stroke (n=3), bilateral optic neuritis (n=1), abducens nerve palsy (n=1), autoimmune haemolytic anemia (n=1), nephrotic syndrome (n=1), splenic infarction (n=2), acute abdomen (n=2), hemiplegia (n=2), psychomotor agitation (n=7), sepsis (n=5), shock (n=3), disseminated intravascular coagulation (n=3) and urticaria (n=2). Six children with vivax presented in deep coma.
Conclusions: Clinicians in endemic areas should be aware of unusual and varied presentations of malaria; failure of recognition of which may lead to delayed diagnosis resulting in increased mortality.
References
Zaki SA, Shanbag P. Atypical manifestations of malaria. Res Rep Trop Med. 2011;2:9-22.
Karnik ND, Yadav DS. Vivax malaria: Benign No more. J Asso Phy India. 2018;66:13-4.
Chandy CJ. Malaria (Plasmodium) In: Behrman RE, Kliegman RM, Stanton BF, editors. Nelson Textbook of Pediatrics, 21st ed. Philadelphia, PA: WB Saunders. 2019;1851-62.
Mishra S, Agarwalla SK, Nanda AK. Case reports on atypical presentation of Plasmodium falciparum malaria in pediatric patients. J Nat Sci Biol Med. 2015;6(2):434-6.
Goyal VK, Chhangani NP. Vivax malaria infection manifesting as Fulminant Hepatic Failure: A Case Report. Int J Clin Pediatr. 2015;4(1):137-8.
Srivastava A, Khanduri A. Falciparum malaria with acute liver failure. Trop Gastroenterol. 1996;17(3):172-4.
White NJ, Breman JG. Malaria and Babesiosis. In Kasper DL, Braunwald E, Fauci AS, editors. Harrison’s Principles of Internal Medicine, 20th edition. McGraw-Hill. 2004;1575-90.
Taylor WR, Canon V, White NJ. Pulmonary manifestations of malaria: recognition and management. Treat Respir Med. 2006;5(6):419-28.
Chiabi A, Bogne JB, Nguefack S. Post malaria neurological syndrome in a Cameroonian child after a Plasmodium falciparum malaria infection. J Public Health Emerg. 2017;1:6.
Almuntaser S, Costello A, Lynch B. Post-malaria neurological syndrome: the first Irish paediatric case. Arch Dis Child. 2018;103(1):A1-A212.
Webster W, Albert JK. The Psychiatric manifestations of cerebral malaria. Am J Psychiatry. 2006;125(2):192-6.
Gaurav MK, Bhargava AN. Post-Plasmodium vivax malaria cerebellar ataxia and optic neuritis. J Pediatr Neurosci. 2015;10(1):58-60.
Singh R, Rajnish I, Lieber J. Plasmodium falciparum induced nephrotic syndrome in a traveller. Am J Kidney Dis. 2016;67(5):A1-A118 .
Hwang JH, Lee CS. Malaria induced Splenic Infarction. Am J Trop Med Hyg. 2014;91(6):1094-100.
