title: Clinical profiles of 13 children with Plasmodium vivax cerebral malaria.
abstract: BACKGROUND
  Bikaner region is endemic for both P. vivax and P. falciparum malaria. Usually, cerebral malaria is caused by P. falciparum but it has been reported recently also in P. vivax mono-infection. Epidemiologic studies and  clinical descriptions of P. vivax cerebral malaria in children are rare.
  
  
  OBJECTIVE
  To describe the clinical features of PCR-confirmed cerebral malaria owing to P. vivax mono-infection and its clinico-laboratory profile in Bikaner, Northwest India.
  
  
  METHODS
  This  observational prospective study was based on detailed clinical and laboratory investigation of children admitted with cerebral malaria owing to P. vivax between November 2008 and December 2010. Cerebral malaria was categorised according to the WHO (2000) criteria for P. falciparum  and the diagnosis of P. vivax mono-infection was established by peripheral blood film and rapid diagnostic tests and confirmed by polymerase chain reaction. The possibility of other diseases/infections causing similar illness were investigated thoroughly.
  
  
  RESULTS
  Thirteen  children with P. vivax cerebral malaria were studied, eight of whom (61·5%) had multi-organ (two or more organs) dysfunction. Other associated severe manifestations included severe anaemia (7), hepatic dysfunction (2), renal dysfunction (2), bleeding manifestation (2), respiratory  distress (2), metabolic acidosis (2) and shock (one). Hypoglycaemia was not observed in any patient. There was no evidence of neurological sequelae. All the children were managed according to WHO guidelines using intravenous artisunate. Thrombocytopenia was detected in five and hyponatraemia  in four children.
  
  
  CONCLUSIONS
  P. vivax mono-infection can cause cerebral malaria and multi-organ dysfunction.
authors: Kothari Medical & Research Institute, Bikaner, Rajasthan, India.
authors: G S
authors: GS
authors: Tanwar
authors: P C
authors: PC
authors: Khatri
authors: G S
authors: GS
authors: Sengar
authors: A
authors: A
authors: Kochar
authors: S K
authors: SK
authors: Kochar
authors: S
authors: S
authors: Middha
authors: G
authors: G
authors: Tanwar
authors: N
authors: N
authors: Khatri
authors: D
authors: D
authors: Pakalapati
authors: S
authors: S
authors: Garg
authors: A
authors: A
authors: Das
authors: D K
authors: DK
authors: Kochar
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007194:India; D016779:Malaria, Cerebral / Q000473:pathology*; D016780:Malaria, Vivax / Q000150:complications* / Q000473:pathology*; D008297:Male; D008853:Microscopy; D018512:Parasitemia / Q000175:diagnosis / Q000469:parasitology; D010966:Plasmodium vivax / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D011446:Prospective Studies
chemical_list: D016054:DNA, Protozoan