Plasmodium vivax malaria, one of the types of this protozoal disease, is considered to be a global health problem, as it causes up to 390 million clinically apparent infections every year on several continents [1]. P. vivax, transferred by the Anopheles family of mosquitoes to the human host, primarily causes infection in South East Asia and the Central/South America, whereas only a few African countries (Madagascar, Sudan) are the site of P. vivax malaria infection [1] [2] [3]. The pathogenesis of malaria lies in the ability of the protozoa to cause red blood cell (RBC) destruction and a severe inflammatory reaction. Similarly to other types of malaria, the clinical presentation is comprised of chills, myalgia, and high fever, but the 48 hour-cyclic appearance (tertian fever) is a highly specific finding for P. vivax and P. ovale [4]. Additional findings include malaise, abdominal pain, gastrointestinal irritation (nausea, vomiting, diarrhea), jaundice, hepatosplenomegaly, anemia, and a cough [5] [6] [7] Although P. vivax was until recently interpreted as a milder form of malaria, studies have confirmed the increasing presence of prostration, respiratory insufficiency, persistent vomiting and hyperpyrexia in patients suffering from this type of malaria [8]. The incubation period may be quite long, as certain forms of P. vivax inhabit the human liver and remain dormant for a significant period of time (week, months or even years might pass before the onset of symptoms or relapse) [7]. The relapsing and remitting course of the disease, as well as its challenging therapy (but also a delayed diagnosis), are major issues when treating these patients, and requires a comprehensive approach.

• Fever

  Fever and chills developed in all cases. Of the forty-two cases whose fever patterns were noted in the records, 15 (35.7%) developed tertian fever; 22 (54.8%) had fevers daily, and 5 had irregular fever patterns ( Figure 3 ). [kjim.org]

  Similarly to other types of malaria, the clinical presentation is comprised of chills, myalgia, and high fever, but the 48 hour-cyclic appearance (tertian fever) is a highly specific finding for P. vivax and P. ovale. [symptoma.com]

  We report a case of Plasmodium vivax and murine typhus coinfection in a 30-year-old woman who presented with intermittent, high-grade fever. [ncbi.nlm.nih.gov]

• Chills

  Similarly to other types of malaria, the clinical presentation is comprised of chills, myalgia, and high fever, but the 48 hour-cyclic appearance (tertian fever) is a highly specific finding for P. vivax and P. ovale. [symptoma.com]

  A 37-year-old Ethiopian male presented with a 4-month history of chills, chronic diarrhea and weight loss. He was diagnosed with P. vivax malaria, advanced HIV infection and Isospora belli enteritis. [ncbi.nlm.nih.gov]

  Malaria is a disease characterized by the cyclical occurrence of fever, chills, and sweating that has been recognized since antiquity. [microscopyu.com]

• Rigor

  […] the differential diagnosis for febrile patients with a history of travel to malarious areas, health-care providers also should consider malaria as a possible cause of fever among patients who have not traveled but are experiencing alternating fevers, rigors [ncbi.nlm.nih.gov]

  The proposers have demonstrated that clinical paroxysms in P.vivax malaria i.e., periodic episodes of fever with chills and rigors, are accompanied by a transient but massive rise in serum TNF levels. [cordis.europa.eu]

  A 62-year-old female presented in the emergency department with complaints of fever for the last 4 days which was intermittent in nature and was associated with chills and rigor. On examination, she was febrile with an oral temperature of 104°F. [ijccm.org]

  Case Report A 43-year-old male, resident of eastern India, arrived at the hospital emergency room with complaints of high grade, intermittent fever associated with chills and rigors during seven days. [scielo.br]

  Case Report A 35 years old male, non diabetic, non hypertensive was admitted following fever for two days with chills, rigor and associated non productive cough and breathing difficulty for two days. [pubs.sciepub.com]

• Intermittent Fever

  An infant developed intermittent fever 20 days after delivery. [ncbi.nlm.nih.gov]

  On the fourth day of admission, she had intermittent fever, developed dyspnoea and chest radiograph showed bilateral interstitial infiltration. [casereports.bmj.com]

  Case Report A 43-year-old male, resident of eastern India, arrived at the hospital emergency room with complaints of high grade, intermittent fever associated with chills and rigors during seven days. [scielo.br]

  Case presentation A 22-day-old female infant delivered from a Pakistani mother was referred to the Department of Neonatology and Neonatal Intensive Care, Spedali Civili, Brescia, for intermittent fever of one week duration with picks above 39 C°. [malariajournal.biomedcentral.com]

  Case 1 A 28-year-old female presented with high and intermittent fever for more than three days, chills, nausea, cold sweat, and heartburn but no bleeding. Last year, she worked in Papua and was twice hospitalised because of malaria. [hindawi.com]

• Fatigue

  Patients with moderate to severe degree fever, with chills, localized and generalized body ache, varying degrees of weakness/fatigue and malaise/lethargy, vomiting suspected clinically to be suffering from malaria were tested - by peripheral smear examination [ijidonline.com]

  It is also worth noting that, in the beginning, malaria feels much like the flu as victims experience symptoms such as fatigue, high fever, hot and cold stages as well as body aches. [interestingengineering.com]

  Symptoms Signs and symptoms of malaria may include: Fever Chills General feeling of discomfort Headache Nausea and vomiting Diarrhea Abdominal pain Muscle or joint pain Fatigue Rapid breathing Rapid heart rate Cough Some people who have malaria experience [mayoclinic.org]

  […] in France since 2012 and having not traveled in an endemic area since that date, was admitted on 2nd of August 2015, 24 h after the symptoms onset, to the emergency unit of the Avicenne hospital because of abdominal pain, intense headache, fever and fatigue [malariajournal.biomedcentral.com]

• Cough

  He had a history of exposure to COVID-19, after which he experienced fever, headache, and cough and was diagnosed as mild COVID-19 upper respiratory tract illness. [dovepress.com]

  Additional findings include malaise, abdominal pain, gastrointestinal irritation (nausea, vomiting, diarrhea), jaundice, hepatosplenomegaly, anemia, and a cough Although P. vivax was until recently interpreted as a milder form of malaria, studies have [symptoma.com]

  We report a case of ARDS complicating infection with Plasmodium vivax malaria. » Case Report A 42-year-old male patient was admitted with fever, chills, dry cough, headache, and body pain for 1 week. [ijccm.org]

  There was no history of cough, pain abdomen, vomiting, or burning micturition. There was no history of any addiction. Patient first consulted at a clinic and was prescribed paracetamol tablet. [atmph.org]

  Case Report A 35 years old male, non diabetic, non hypertensive was admitted following fever for two days with chills, rigor and associated non productive cough and breathing difficulty for two days. [pubs.sciepub.com]

• Tachypnea

  He was febrile (39.9 degree Celsius), tachycardiac (136 beats per minute), but had no tachypnea (18 breaths per minute), a normal blood pressure (120/80 mm Hg) and was maintaining oxygen saturation of 97% on room air. [dovepress.com]

  On the third day of admission, the patient developed dyspnea and tachypnea with a respiratory rate of 45 to 50 /min and pulse oximetry showed decreased oxygen saturation (86% breathing on room air). He was shifted to the Intensive Care Unit. [ijccm.org]

• Respiratory Insufficiency

  insufficiency, persistent vomiting and hyperpyrexia in patients suffering from this type of malaria. [symptoma.com]

• Vomiting

  […] confirmed the increasing presence of prostration, respiratory insufficiency, persistent vomiting and hyperpyrexia in patients suffering from this type of malaria. [symptoma.com]

  This report highlights the occurrence of acute glomerulonephritis in a 7-year-old girl who presented with fever and vomiting. Peripheral smear examination demonstrated ring forms of P. vivax. [ncbi.nlm.nih.gov]

  Results The majority of the patients presented with high-grade fever accompanied by projectile vomiting and abnormal behaviour, seizures, shock and unconsciousness. [rcpe.ac.uk]

  Symptoms of uncomplicated P. vivax malaria In the uncomplicated form of the disease, initial non-specific symptoms appear, including fever with chills, headache, muscle pain (myalgia), nausea, vomiting, appetite loss and arthralgia (joint pain). [vivaxmalaria.org]

• Nausea

  Symptoms of uncomplicated P. vivax malaria In the uncomplicated form of the disease, initial non-specific symptoms appear, including fever with chills, headache, muscle pain (myalgia), nausea, vomiting, appetite loss and arthralgia (joint pain). [vivaxmalaria.org]

  Additional findings include malaise, abdominal pain, gastrointestinal irritation (nausea, vomiting, diarrhea), jaundice, hepatosplenomegaly, anemia, and a cough Although P. vivax was until recently interpreted as a milder form of malaria, studies have [symptoma.com]

  Signs and Symptoms Patient experiences vague influenza-like symptoms with headache, muscle pains, photophobia, anorexia, nausea, and vomiting. [microbenotes.com]

  […] other & to walls of capillaries; depriving tissues of O2; spleen enlarges Located in endemic regions of Africa & s.e. asia Mosquito bite, mother to fetus, transfusion, shared needles, organ transplant None to sever: fever, chills, sweats, headache, nausea [quizlet.com]

  Case 2 A 29-year-old pregnant female had fever 9 days before admission, also chills, nausea, vomiting, and melena. [hindawi.com]

• Abdominal Pain

  Physicians should suspect and investigate for this rare complication if a patient with malaria complains of left upper quadrant abdominal pain, pleuritic left lower chest pain and/or enlarging tender splenomegaly during the course of malaria infection [ncbi.nlm.nih.gov]

  Additional findings include malaise, abdominal pain, gastrointestinal irritation (nausea, vomiting, diarrhea), jaundice, hepatosplenomegaly, anemia, and a cough Although P. vivax was until recently interpreted as a milder form of malaria, studies have [symptoma.com]

  Three months later, 48 h after the symptoms onset, the patient came back again for fever (38.5 °C), headache, arthralgia, myalgia, abdominal pain and subsequently, vomiting and diarrhoea. [malariajournal.biomedcentral.com]

  Thirteen cases (29.5%) complained of abdominal pain, and 15 cases (34.1%) had gastrointestinal symptoms such as nausea, vomiting, and diarrhea. [kjim.org]

  pain, headache and muscle aches and pains Patients with P. vivax or P. ovale infection may have relapses after many months or years Diagnosis Growing trophozoites of P. vivax have irregular shapes and are termed ameboid Identification of malarial parasites [pathologyoutlines.com]

• Intestinal Disease

  […] to antimicrobial drugs ( Z16.- ) Certain infectious and parasitic diseases B50-B64 2019 ICD-10-CM Range B50-B64 Protozoal diseases Type 1 Excludes amebiasis ( A06.- ) other protozoal intestinal diseases ( A07.- ) Protozoal diseases B51 ICD-10-CM Diagnosis [icd10data.com]

• Tachycardia

  Patients present with abdominal pain, fever, tachycardia, prostration and rapidly developing anemia and hypotension. Some of these manifestations are seen in malaria itself and therefore splenic rupture can be easily missed. [malariasite.com]

• Jaundice

  Severe P. vivax malaria with cholestatic jaundice in neonates is an uncommon condition that should be included in the differential diagnosis of infants displaying hemolytic anemia, thrombocytopenia, cholestatic jaundice, and hepatosplenomegaly in malaria-endemic [ncbi.nlm.nih.gov]

  Anemia, jaundice, and hypoglycemia were less severe forms of complications. The combination of cerebral malaria, jaundice, renal failure and anemia was more fatal. [tropicalparasitology.org]

  After a detailed physical examination, which may detect hepatosplenomegaly and jaundice, laboratory studies are the next step. [symptoma.com]

• Epistaxis

  Out of these 35, 8 patients presented with spontaneous bleeding in the form of epistaxis, gum bleed, or petechial rashes on skin. [annalsafrmed.org]

  Bleeding due to thrombocytopenia was seen in the form of epistaxis, petechiae, ecchymoses, and hematuria. The platelet count increased with the treatment of malaria. [tropicalparasitology.org]

• Confusion

  Unidentified structures initially confusing to the diagnosticians were seen in blood smears taken on admission. [ncbi.nlm.nih.gov]

  Rarely, exflagellation has been reported in the peripheral blood of humans, and the presence of exflagellation might create confusion during diagnosis. [bloodjournal.org]

  As for neurological disorders, the symptoms were agitation in 2 (1.4%), drowsiness in 2 (1.4%), mental confusion in 1 (0.7%), loss of consciousness in 2 (1.4%), and seizures in 2 (1.4%). [scielo.br]

  Murine typhus with severe manifestation as pneumonitis is atypical manifestation. 3 4 In particular, coinfection between murine typhus and malaria is likely to be underdiagnosed or may be confused with other acute febrile infections. 5 In this present [casereports.bmj.com]

  With severe malaria, caused by P. falciparum, victims begin to experience more intense symptoms including neurological focal signs, anemia, confusion, dypsnea, and even coma. Again, these symptoms are shared with many other diseases. [microbewiki.kenyon.edu]

• Vertigo

  Fixed, 95% CI) 0.66 [0.33, 1.33] 1.3.3 Nausea 2 504 Risk Ratio (M‐H, Fixed, 95% CI) 1.05 [0.53, 2.07] 1.3.4 Vomiting 2 504 Risk Ratio (M‐H, Fixed, 95% CI) 1.29 [0.57, 2.93] 1.3.5 Diarrhoea 2 504 Risk Ratio (M‐H, Fixed, 95% CI) 1.03 [0.42, 2.50] 1.3.6 Vertigo [cochranelibrary.com]

The diagnosis of P. vivax malaria must be made early on, as 10-20% of patients are estimated to suffer from a severe form of illness, for whom mortality rates range between 5-15% [3]. The ability of the physician to recognize signs and symptoms of malaria is vital. Patients should be asked about recent travel (possibly to endemic areas) and whether the symptoms appear in a specific fashion (tertian fever). After a detailed physical examination, which may detect hepatosplenomegaly and jaundice, laboratory studies are the next step. A complete blood count (CBC) will virtually always reveal anemia, and thrombocytopenia up to a certain extent [4] [7], while a complete biochemical workup is recommended. To confirm the diagnosis of malaria and determine the specific subtype, several tests have been described in the literature, such as peripheral blood smear examination, microscopy, rapid diagnostic testing and polymerase chain reaction (PCR) [7] [9]. Although microscopic techniques and blood smear examinations lack sensitivity, they are a superior method for the detection of Plasmodium species, but these sophisticated tests are rarely available in areas affected by malaria [9]. Thus, rapid diagnostic tests (RDTs), which are able to detect malarial antigen in blood and cost less are easily performed in this setting [9].

Follow-on treatment Following parentarel artesunate, treatment can be completed with a full treatment course of oral ACT or chloroquine (in countries where chloroquine is the treatment of choice). [severemalaria.org]

Parenteral artesunate or quinine is recommended for treatment of severe malaria. Speciation of plasmodium is required, as P. vivax and P. ovale require additional treatment to eliminate dormant parasites (radical cure). [antimicrobialstewardship.com]

SLCO1A2 and SLCO1B1 gene treatment over time interactions were associated with gametocytemia clearance rate (p FDR = 0.018 and p FDR = 0.024). ABCB1, ABCC4 and SLCO1B3 were not associated with treatment response. [ncbi.nlm.nih.gov]

Of the various species, Plasmodium Falciparum is associated with serious prognosis,(morbidity and mortality) in a sizeable number of patients. [ijidonline.com]

[…] malaria has a good prognosis and causes significantly fewer complications than falciparum malaria. [ncbi.nlm.nih.gov]

We found the data supported a role for P. vivax in the etiology of undernutrition in endemic areas. Thus, the application of modern causal inference tools, in future studies, may be useful in determining causation. [ncbi.nlm.nih.gov]

[…] clinically by fever, anemia and splenomegaly and is caused by apicomplexan parasites of the genus Plasmodium P. vivax infections occur in both tropical and temperate zones, between 45° N and 40° S ( WHO: Malaria [Accessed 10 January 2018] ) Pathophysiology / etiology [pathologyoutlines.com]

In a retrospective study on 93 patients of malarial ARF 19 (20.4%) were found due to p. vivax infection. [21] Etiology of renal failure in malaria is multifactorial, volume depletion, intravascular hemolysis, and hyperbilirubinaemia are factors considered [annalsafrmed.org]

The epidemiology of P. vivax varies substantially within India, including multiple relapse phenotypes with varying latencies between primary infection and relapse. [ncbi.nlm.nih.gov]

Tags: genetic epidemiology; homologous genotype; homologous recurrence; hypnozoite; malaria; molecular epidemiology; Plasmodium vivax; relapse Miles Markus's blog Log in or register to post comments 3991 reads [malariaworld.org]

Plasmodium vivax-associated ARDS is a clinically recognisable condition whose underlying pathophysiology is likely to reflect processes that are independent of parasite sequestration in the pulmonary microvasculature. [ncbi.nlm.nih.gov]

REVIEW ARTICLE Year : 2018 | Volume : 55 | Issue : 1 | Page : 1-8 Epidemiology, drug resistance, and pathophysiology of Plasmodium vivax malaria 1 Department of Biochemistry, K.S. [jvbd.org]

Thus, to reduce the overall burden of morbidity and mortality of malaria a clinician needs to be vigilant and acquainted even with the rarest of rare pathophysiological aspects of various complications of malaria. [atmph.org]

Pathophysiology of cerebral malaria: role of host cells in the modulation of cytoadhesion. Ann N Y Acad Sci 2003 ; 992: 30 – 38. Google Scholar | Crossref | Medline | ISI 9. [journals.sagepub.com]

This case highlights the importance of preventing malaria cases among nonimmune or semi-immune individuals traveling to P vivax-endemic areas. [ncbi.nlm.nih.gov]

For certain diseases this kind of T cell inducing vaccine could be very important in their ability to prevent it. [ndm.ox.ac.uk]

Intermittent preventive treatment for the prevention of malaria during pregnancy in high transmission areas. Malar J. 2007 Dec 4. 6:160. [Medline]. [Full Text]. Trape JF, Tall A, Diagne N, et al. [medscape.com]

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