Abstract

Background: Malaria continues to be a major public health problem in South East Asia. Plasmodium vivax is the most widely distributed human malaria parasite with an at-risk population of 2.5 billion persons. With the implementation of molecular diagnosis, it has become evident that P.vivax mono infection could also result in multiple organ dysfunction and severe life-threatening disease as seen in P. falciparum infection. Objectives: To study the changing trends in the clinical and hematological presentation of the Plasmodium vivax malaria and to sensitize the health care provider about the changing presentation of the Plasmodium vivax mono infection and to introduce a high index of suspicion against it’s potentially life threatening complications hitherto considered not significantly prevalent, by printing and publishing the data thus obtained and circulating it amongst the health care providers in and around Amritsar. Methods: This is a single center prospective study including 100 children attending thalassemia day care center and on regular blood transfusion therapy for a minimum of 2 years and whose ferritin level is above 1000 μgm/dl. Detailed history and examination were recorded in the proforma. Blood was drawn for thyroid function tests and most recent ferritin value obtained from patients record was used for analysis. Results: A total of 55 cases of vivax malaria were included in the study. Severe disease was present in 19(34.5%) cases of malaria. In addition to fever, the most common clinical features at presentation in children were: fatigue in 96.4%(53/55), headache in 54% (30/55), myalgia in 54%(30/55), arthralgia in 43%(24/55), vomiting in 64% (35/55) and nausea in 58%(32/55).Hepatosplenomegaly in 51% (28/55) of patients, splenomegaly in 26% (14/55) and hepatomegaly alone in 3% (2/55), varying degrees of icterus in 20% (11/55) and respiratory distress in 12.7% (7/55). Anemia was present in 89.1% (49/55) and thrombocytopenia (platelet count < 1,50,000/μL) was present in 45.5% (25/55) of the children. Conclusion: In recent years, the clinical pattern of vivax malaria has changed. Severe vivax malaria is now very common with increasing mortality. Not only the number, but also the type of complication influences the outcome of complicated malaria.

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