Changes in hematological manifestations in children with vivax malaria

Ankit Mangla, Atul Goel, Tejinder Singh

Abstract


Background: Malaria, especially Plasmodium falciparum is commonly associated with haematological abnormalities like anemia and thrombocytopenia. Vivax malaria, on the other hand was usually considered as a relatively benign illness. However over last decade or two, it is being increasingly realized that the vivax malaria is not a benign illness anymore. There have been number of reports and case series demonstrating severe haematological and clinical manifestations associated with vivax malaria mono-infection.

Methods: The study group consisted of 132 cases of vivax mono-infection diagnosed on thick and thin blood smear examination, which were recorded from the retrospective data starting from June 2002 to December 2011 and the prospective part of study from January 2012 to July 2013.

Results: Thrombocytopenia was the most common haematological manifestation in vivax malaria and has seen a significant increase from 62.9% to 87.2% from time period A to C. The proportion of children with anaemia in vivax malaria has increased from 69.4% in time period A to 78.6%. The incidence of leucocytopenia was seen in 25% cases of vivax monoinfection, with no significant change being observed over different time periods when compared among cases of vivax malaria.

Conclusions: Vivax malaria was observed to be increasingly associated with thrombocytopenia and anemia over last decade. 


Keywords


Malaria, Vivax, Thrombocytopenia, Anaemia

Full Text:

PDF

References


Guerra CA, Howes RE, Patil AP, Gething PW, Van Boeckel TP, Temperley WH, et al. The International Limits and Population at Risk of Plasmodium vivax Transmission in 2009. PLoS Negl Trop Dis. 2010;4(8):e774.

Moulin F, Lesage F, Legros A, Maroga C, Moussavou A, Guyon P, et al. Thrombocytopenia and Plasmodium falciparum malaria in children with different exposures. Arch Dis Child. 2003;88:540-1.

Rodríguez-Morales AJ, Sánchez E, Vargas M, Piccolo C, Colina R, Arria M. Anemia and thrombocytopenia in children with Plasmodium vivax malaria. J Trop Pediatr. 2006;52:49-51.

Beale PJ, Cormack JD, Oldrey TB. Thrombocytopenia in malaria with immunoglobulin (IgM) changes. Br Med J. 1972;1(5796):345-9.

Horstmann RD, Bienzle U, Rasche H. Malaria-induced thrombocytopenia. Blut. 1981;42(3):157-64.

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.

Joshi HA, Shah SS. Thrombocytopenia in P. vivax malaria. NJIRM. 2012;3:125-8.

Sharma A, Khanduri U. How benign is benign tertian malaria. J Vector Borne Dis. 2009;46:141-4.

Makkar RPS, Monga SMA, Gupta AK. Plasmodium vivax malaria presenting with severe thrombocytopenia. Braz J Infect Dis. 2002;6(5):263-5.

Limaye CS, Londhey VA, Nabar ST. The study of complications of vivax malaria in comparison with falciparum malaria in Mumbai. J Assoc Physicians India. 2012;60:15-8.

Lança EFC, Magalhães BML, Vitor-Silva S, Siqueira AM, Benzecry SG, Alexandre MAA, et al. Risk factors and characterization of Plasmodium vivax-associated admissions to pediatric intensive care units in the Brazilian Amazon. PLoS One. 2012;7(4):e35406.

Mehmood A, Ejaz K, Ahmed T. Severity of Plasmodium vivax Malaria in Karachi: a cross-sectional study. J Infect Dev Ctries. 2012;6:664-70.

Fajardo LF. Malarial parasites within human platelets. JAMA. 1974;229:1205-7.

Yamaguchi S, Kubota T, Yamagishi T, Okamoto K, Izumi T, Takada M, et al. Severe thrombocytopenia suggesting immunological mechanisms in two cases of vivax malaria. Am J Hematol. 1997;56:183-6.

Erel O, Vural H, Aksoy N, Aslan G, Ulukanligil M. Oxidative stress of platelets and thrombocytopenia in patients with vivax malaria. Clin Biochem. 2001;34:341-4.

Genton B, D’Acremont V, Rare L, Baea K, Reeder JC, Alpers MP, et al. Plasmodium vivax and mixed infections are associated with severe malaria in children: a prospective cohort study from Papua New Guinea. PLoS Med. 2008;5(6):e127.

Shaikh S, Memon H, Shaikh A, Ahmed I, Iohano B, Baird K. Severe disease in children hospitalized with a diagnosis of Plasmodium vivax in South-Eastern Pakistan. Malar J. 2012;11:144.

Mahgoub H, Gasim GI, Musa IR, Adam I. Severe Plasmodium vivax malaria among Sudanese children at New Halfa Hospital, Eastern Sudan. Parasit Vect. 2012;5:154.

Ratcliff A, Siswantoro H, Kenangalem E, Wuwung M, Brockman A, Edstein M, et al. Therapeutic response of multidrug-resistant Plasmodium falciparum and P. vivax to chloroquine and sulfadoxine–pyrimethamine in Southern Papua, Indonesia. Trans R Soc Trop Med Hyg. 2007;101(4-4):351-9.

Douglas NM, Anstey NM, Buffet PA, Poespoprodjo JR, Yeo TW, White NJ, et al. The anaemia of Plasmodium vivax malaria. Malar J. 2012;11:135.

Anstey NM, Douglas NM, Poespoprodjo JR, Price RN. Plasmodium vivax: clinical spectrum, risk factors and pathogenesis. Adv Parasitol. 2012;80:151-201.

Collins WE, Jeffery GM, Roberts JM. A retrospective examination of anemia during infection of humans with Plasmodium vivax. Am J Trop Med Hyg. 2003;68:410-2.

Singh R, Kumar S, Rana S, Thakur B, Singh S. A comparative study of clinical profiles of vivax and falciparum malaria in children at a tertiary care centre in Uttarakhand. J Clin Diagn Res. 2013;7:2234-7.