Thrombocytopenia in Plasmodium falciparum, Plasmodium vivax and mixed infection malaria: a study from Bikaner (Northwestern India).
The occurrence, relation and magnitude of thrombocytopenia in different species of malaria are not clearly defined. This study included 1,064 patients admitted with malaria to study thrombocytopenia (platelet count <150,000 /cumm) in Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) mono infection and mixed infection (Pf + Pv). The species diagnosis was done by peripheral blood film (PBF) and rapid diagnostic test (RDT). Validation by polymerase chain reaction (PCR) was done only in patients with severe thrombocytopenia (platelet count <20,000 /cumm). The breakup of patients was 525 (49.34%) Pf, 460 (43.23%) Pv and 79 (7.42%) mixed malaria (Pf + Pv). Thrombocytopenia was observed in 24.6% (262/1064) patients. The risk was greatest in the mixed infections in comparison to monoinfection individually (43.04% [34/79]; mixed vs Pv monoinfection: Odds Ratio [OR] = 1.675 [95% Confidence Interval (CI) 1.029-2.726], p < 0.0366; mixed vs Pf monoinfection: OR=3.911 [95% CI 2.367-6.463], p < 0.0001). Pv monoinfection (31.09% [143/460]) had greater risk compared to Pf monoinfection (16.19% [85/525]; OR = 2.335 [95% CI 1.722-3.167], p < 0.0001). The occurrence of severe thrombocytopenia was also higher in Pv monoinfection (18.18% [26/143]) in comparison to either Pf monoinfection (10.59% [9/85], OR = 1.877 (95% CI 0.834-4.223)) or mixed infection (11.76% [4/34]; OR = 1.667 (95% CI 0.540-5.142) but this association was statistically not significant. Six patients (3 Pv, 2 Pf and 1 mixed) developed severe epistaxis requiring platelet transfusion. There was no relation between parasite density and platelet count as many patients with severe thrombocytopenia had parasite density similar to patients without thrombocytopenia. We found that the association of thrombocytopenia was statistically more significant with P. vivax monoinfection as compared to P. falciparum.
Department of Medicine, Kothari Medical & Research Institute, Bikaner, India. drdkkochar@yahoo.com
Dhanpat Kumar
DK
Kochar
Ashis
A
Das
Abhishek
A
Kochar
Sheetal
S
Middha
Jyoti
J
Acharya
Gajanand Singh
GS
Tanwar
Anjana
A
Gupta
Deepak
D
Pakalapati
Shilpi
S
Garg
Vishal
V
Saxena
Amit Kumar
AK
Subudhi
P A
PA
Boopathi
Parmendra
P
Sirohi
Sanjay Kumar
SK
Kochar
D000328:Adult; D000818:Animals; D016054:DNA, Protozoan / Q000032:analysis; D003955:Diagnostic Tests, Routine; D006801:Humans; D007194:India; D008288:Malaria / Q000097:blood / Q000150:complications / Q000469:parasitology; D010963:Plasmodium falciparum / Q000235:genetics / Q000472:pathogenicity*; D010966:Plasmodium vivax / Q000235:genetics / Q000472:pathogenicity*; D010976:Platelet Count; D012307:Risk Factors; D013921:Thrombocytopenia / Q000209:etiology / Q000469:parasitology
D016054:DNA, Protozoan