title: Plasmodium vivax malaria: is it actually benign?
abstract: Plasmodium vivax (Pv) malaria is being increasingly recognized as a cause of severe malaria in children.
  
  
  OBJECTIVE
  To describe the various severe manifestations associated with vivax malaria by retrospective analysis of records.
  
  
  METHODS
  Children between the ages of 0 and 18 years with a confirmed diagnosis of Pv malaria monoinfection done by peripheral blood film (PBF) and/or rapid diagnostic test (RDT) admitted between June and September 2009 were included. Their clinical, hematological and biochemical manifestations were analyzed.
  
  
  RESULTS
  Twenty-three patients of Pv malaria were retrospectively analyzed. Thrombocytopenia was present in 22 (96%) patients with counts less than 50,000/ μL in 9 patients. Severe anemia (hgb<5mg/dl) was present in 8 (34%) patients. Cerebral malaria was present in 3 patients. Liver enzymes were elevated (>3 times normal) in 4 (17.3%) patients while jaundice (bilirubin>2.5mg/dl) was present in 2 patients (total bilirubin 5.2mg/dl and 14.3mg/dl). Renal dysfunction (creatinine>3mg/dl) was present in 6 (26%) patients with 2 patients showing severely deranged renal functions (blood urea 168 mg/dl, 222 mg/dl and serum creatinine 5.0mg/dl, 5.6 mg/dl, respectively). Hypernatremia was present in one patient. One patient expired within 12h of presentation because of severely deranged hepatic and renal dysfunction.
  
  
  CONCLUSIONS
  Pv malaria can lead to unusual and fatal complications. All new guidelines should include "Severe Vivax malaria" as a clinical entity. Further research into the etiopathogenesis and treatment would be important.
authors.affiliation: Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India. dr harpal81@yahoo.co.in
authors.forename: Harpal
authors.initials: H
authors.lastname: Singh
authors.forename: Ankit
authors.initials: A
authors.lastname: Parakh
authors.forename: Srikanta
authors.initials: S
authors.lastname: Basu
authors.forename: Bimbadarh
authors.initials: B
authors.lastname: Rath
mesh_terms: D000740:Anemia / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D004798:Enzymes / Q000097:blood; D005260:Female; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology; D008099:Liver / Q000473:pathology; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology; D008111:Liver Function Tests; D016779:Malaria, Cerebral / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D016780:Malaria, Vivax / Q000150:complications* / Q000401:mortality / Q000473:pathology*; D008297:Male; D010966:Plasmodium vivax / Q000472:pathogenicity*; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000453:epidemiology / Q000209:etiology
chemical_list: D004798:Enzymes