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Plasmodium Vivax Malaria

Plasmodium vivax malaria is endemic and often neglected protozoal infection that is distinguished by a delayed clinical presentation and a milder clinical course in the initial stages of the disease. Fever, chills, hepatosplenomegaly and anemia are most important symptoms. The diagnosis can be made through several tests, but a thorough clinical assessment is vital for raising suspicion toward malaria as the underlying cause.


Presentation

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
  • 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]
  • An infant developed intermittent fever 20 days after delivery.[ncbi.nlm.nih.gov]
  • […] are experiencing alternating fevers, rigors, and sweats with no obvious cause.[ncbi.nlm.nih.gov]
  • Patients 5 years of age with either fever or history of fever, and laboratory-confirmed P. vivax monoinfection received chloroquine (total dose 25 mg/kg) and primaquine (total dose 3.5 mg/kg), and were followed up for 168 days (24 weeks).[ncbi.nlm.nih.gov]
  • P. vivax should be considered in the differential diagnosis of fever in transplant recipients who had received organs or blood products from malaria-endemic area to facilitate a prompt diagnosis and adequate treatment.[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]
  • CLINICAL PRESENTATION AND INTERVENTION: 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]
  • He presented with symptoms of fever, chills and myalgias. Physical examination revealed significant hepatosplenomegaly.[ncbi.nlm.nih.gov]
  • Despite exhibiting low parasite biomass in infected people due to parasite's specificity to infect only reticulocytes, P. vivax infection triggers higher inflammatory responses and exacerbated clinical symptoms than P. falciparum, such as fever and chills[ncbi.nlm.nih.gov]
  • Despite exhibiting low parasite biomass in infected people due to parasite’s specificity to infect only reticulocytes, P. vivax infection triggers higher inflammatory responses and exacerbated clinical symptoms than P. falciparum , such as fever and chills[jvbd.org]
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]
  • ., 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 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]
  • CASE REPORT A previously healthy 23 year old male, presented to the emergency with chief complaints of high grade fever with chills and rigors but no rash for the last 3 days.[pancreas.imedpub.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 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]
  • Hippocrates was apparently the first to distinguish the intermittent fever of malaria from the continual fever of other infectious diseases. Malaria was long known to be associated with swamps.[microbewiki.kenyon.edu]
Gangrene
  • This index case is the first reported case of peripheral gangrene involving bilateral hands and feet in Pl. vivax infection in an adult.[ncbi.nlm.nih.gov]
  • As far as we are aware, this is the first report of peripheral gangrene associated with P. vivax malaria.[ncbi.nlm.nih.gov]
  • Symmetrical peripheral gangrene in severe Plasmodium vivax malaria. Indian J Crit Care Med 2017;21:245-6 How to cite this URL: Kumar P, Tansir G, Gupta H, Dixit J. Symmetrical peripheral gangrene in severe Plasmodium vivax malaria.[ijccm.org]
Vomiting
  • 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]
  • […] confirmed the increasing presence of prostration, respiratory insufficiency, persistent vomiting and hyperpyrexia in patients suffering from this type of malaria.[symptoma.com]
  • A nine year old boy presented with high grade fever accompanied by projectile vomiting and abnormal behavior later he developed seizures, shock, and unconsciousness. P. vivax monoinfection was diagnosed based on peripheral smears and PCR.[ncbi.nlm.nih.gov]
  • RESULTS: Of the total 63 patients included in the study, 60 (95.2 %) completed their 28-day follow-up; three patients were excluded from the study: one patient due to vomiting of the second dose of drug, one patient due to Plasmodium falciparum infection[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]
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]
  • 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]
  • Other symptoms may include cough and abdominal pain; occasionally, there may be associated respiratory distress or diarrhea.[journals.lww.com]
Upper Abdominal Pain
  • abdominal pain 8 (3.1) 9 (6.8) 6 (4.7) Alanine aminotransferase increased 6 (2.3) 6 (4.5) 3 (2.3) Serious adverse event ‡ 21 (8.1) 6 (4.5) 4 (3.1) Hemoglobin decreased § 14 (5.4) 2 (1.5) 2 (1.6) Diarrhea 1 (0.4) 0 1 (0.8) Drug-induced liver injury ¶[nejm.org]
Chronic Diarrhea
  • CLINICAL PRESENTATION AND INTERVENTION: 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]
Chest 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]
Jaundice
  • Patients exhibited cerebral malaria, renal failure, circulatory collapse, severe anemia, hemoglobinurea, abnormal bleeding, acute respiratory distress syndrome, and jaundice.[ncbi.nlm.nih.gov]
  • The major complications were jaundice and severe anemia. No in vivo chloroquine resistance was detected. These data help characterize the clinical profile of severe P. vivax malaria in Latin America.[ncbi.nlm.nih.gov]
  • The patient presented acute respiratory distress syndrome (ARDS), worsening jaundice, and thrombocytopenia after the administration of antimalarial treatment and despite a decreasing burden of parasitemia.[ncbi.nlm.nih.gov]
  • After a detailed physical examination, which may detect hepatosplenomegaly and jaundice, laboratory studies are the next step.[symptoma.com]
  • Complications observed were hepatic dysfunction and jaundice in 23 (57.5%) patients, renal failure in 18 (45%) patients, severe anemia in 13 (32.5%) patients, cerebral malaria in 5 patients (12.5%), acute respiratory distress syndrome in 4 patients (10%[ncbi.nlm.nih.gov]

Workup

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].

Erythrocytes Decreased
  • CONCLUSIONS: These findings revealed that vivax-infected patients with anaemia have increased levels of IgG auto-antibodies against nRBCs and that their deposition on the surface of non-infected erythrocytes decreases their deformability, which, in turn[ncbi.nlm.nih.gov]

Treatment

  • 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]
  • Two (0.7%) patients experienced early treatment failure and 23 (8%) late treatment failure.[ncbi.nlm.nih.gov]
  • Loss to follow up was noted with 5 (3.1%) participants and non-compliance with treatment regimen occurred with one participant (0.6%).[ncbi.nlm.nih.gov]
  • Treatment failure by day 28 was 61.1% (95% confidence interval [CI], 46.8-75.6) after CQ and 0% (95% CI, 0-.08) following AS-MQ (P .001), of which 8.2% (95% CI, 2.5-9.6) were early treatment failures.[ncbi.nlm.nih.gov]
  • Alternative treatments are under investigation.[ncbi.nlm.nih.gov]

Prognosis

  • As compared with complicated falciparum malaria with ARDS, the prognosis is relatively better in ARDS in patients with complicated vivax malaria. [4] , [5] , [6] , [7] Gastrointestinal hemorrhage as a complication of P. vivax malaria again is extremely[atmph.org]

Etiology

  • 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]
  • The other etiologies of fever and AKI were ruled out. He responded to prompt therapy with antimalarial drugs. There was no change in tacrolimus trough level before and after antimalarial drugs. Two weeks after discharge, his SCr. was 1.43 mg/dl.[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]
  • Lancet 383(9918):723–735. doi: 10.1016/S0140-6736(13)60024-0 PubMed CrossRef Google Scholar Wilson ME, Freedman DO (2007) Etiology of travel-related fever.[link.springer.com]

Epidemiology

  • 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]
  • Further large-scale multicentric epidemiologic studies are needed to define the basic pathology of this less known entity.[ncbi.nlm.nih.gov]
  • This epidemiology highlights the need to register and use primaquine for the treatment of latent-phase P. vivax malaria in Switzerland, a medicine currently neither marketed nor systematically reimbursed.[ncbi.nlm.nih.gov]
  • Author information 1 MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London W2 1PG, UK [email protected] 2 MRC Centre for Outbreak Analysis and Modelling, Department[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]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • This review article summarizes the published information on P. vivax epidemiology, drug resistance and pathophysiology.[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]
  • 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]
  • Lung injury in vivax malaria: pathophysiological evidence for pulmonary vascular sequestration and posttreatment alveolar-capillary inflammation. J Infect Dis 2007; 195:589-96. [PMID: 17230420] Desai DC, Gupta T, Sirsat RA, Shete M.[pancreas.imedpub.com]

Prevention

  • This case highlights the importance of preventing malaria cases among nonimmune or semi-immune individuals traveling to P vivax-endemic areas. [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • We aimed to determine whether unsupervised primaquine was effective for preventing re-presentation to hospital with vivax malaria in southern Papua, Indonesia.[ncbi.nlm.nih.gov]
  • In Udupi district, PQ dose of 0.25 mg/kg/day over 14 days seems inadequate to prevent recurrence in substantial proportion of vivax malaria. Patients with a history of vivax malaria are at high risk of recurrences.[ncbi.nlm.nih.gov]
  • […] and Prevention, Guatemala City, Guatemala.[ncbi.nlm.nih.gov]
  • Malaria transmission has been prevented in 3 border villages in Tengchong County, Yunnan Province, China, by use of active fever surveillance, integrated vector control measures, and intensified surveillance and response.[ncbi.nlm.nih.gov]

References

Article

  1. Price RN, Tjitra E, Guerra CA, Yeung S, White NJ, Anstey NM. Vivax malaria: neglected and not benign. The American journal of tropical medicine and hygiene. 2007;77(6):79-87.
  2. Mendis K, Sina BJ, Marchesini P, Carter R. The neglected burden of Plasmodium vivax malaria. Am J Trop Med Hyg. 2001;64:97–106.
  3. Gething PV, Elyazar IR, Moyes CL, et al. A long neglected world malaria map: Plasmodium vivax endemicity in 2010. PLoS Negl Trop Dis. 2012;6:e1814.
  4. Song HH, Soon Ok O, Kim SH, et al. Clinical Features of Plasmodium Vivax Malaria. Korean J Intern Med. 2003;18(4):220-224.
  5. Douglas NM, Anstey NM, Buffet PA, et al. The anaemia of Plasmodium vivax malaria. Malar J. 2012;11:135.
  6. Arévalo-Herrera M, Lopez-Perez M, Medina L, Moreno A, Gutierrez JB, Herrera S. Clinical profile of Plasmodium falciparum and Plasmodium vivax infections in low and unstable malaria transmission settings of Colombia. Malar J. 2015;14:154.
  7. Trampuz A, Jereb M, Muzlovic I, Prabhu RM. Clinical review: Severe malaria. Crit Care. 2003;7(4):315-323.
  8. Demissie Y, Ketema T. Complicated malaria symptoms associated with Plasmodium vivax among patients visiting health facilities in Mendi town, Northwest Ethiopia. BMC Infect Dis. 2016;16(1):436.
  9. Baird JK, Valecha N, Duparc S, White NJ, Price RN. Diagnosis and Treatment of Plasmodium vivax Malaria. Am J Trop Med Hyg. 2016;95(6 Suppl):35-51.

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Last updated: 2018-06-21 22:21