title: Changing profile of severe malaria in north Indian children.
abstract: OBJECTIVE
  To look for profile of severe malaria and contribution of vivax infection to malarial morbidity in North Indian children.
  
  
  METHODS
  Detailed clinical, biochemical and hematological characteristics of children hospitalized with severe malaria over last 3 y were recorded. Presence of malarial parasite on peripheral smear and/or positive antigen test was considered as diagnostic for malaria.
  
  
  RESULTS
  A total of 131(55.3%) patients with Plasmodium vivax (Pv), 79 (33.3%) with Plasmodium falciparum (Pf) and 27 (11.4%) with mixed infections were admitted. Cerebral malaria, severe anemia and shock were significantly more frequently observed in Pf group, while hepatic, renal, respiratory, and bleeding complications were more commonly seen in Pv patients. Malaria mortality was highest in mixed infection (11.1%), followed by Pf (7.6%) and Pv (3%) group.
  
  
  CONCLUSIONS
  Severe and fatal vivax malaria is an emerging recognized entity and challenges the perception of Pv as a benign disease. Further clinical studies and molecular research is required to understand emergence of severe malaria in vivax mono-infection.
authors.affiliation: Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India. dineshmamc@gmail.com
authors.forename: Dinesh
authors.initials: D
authors.lastname: Yadav
authors.forename: Jagdish
authors.initials: J
authors.lastname: Chandra
authors.forename: Satinder
authors.initials: S
authors.lastname: Aneja
authors.forename: Virendra
authors.initials: V
authors.lastname: Kumar
authors.forename: Praveen
authors.initials: P
authors.lastname: Kumar
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Dutta
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007194:India; D007223:Infant; D016778:Malaria, Falciparum / Q000175:diagnosis* / Q000401:mortality*; D016780:Malaria, Vivax / Q000175:diagnosis* / Q000401:mortality*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
references.citation: PLoS Med. 2008 Jun 17;5(6):e128
references.pmid: 18563962
references.citation: J Infect Dis. 2007 Feb 15;195(4):589-96
references.pmid: 17230420
references.citation: Indian J Pediatr. 2011 Apr;78(4):475-7
references.pmid: 21088935
references.citation: Am J Trop Med Hyg. 2007 Dec;77(6 Suppl):69-78
references.pmid: 18165477
references.citation: Clin Biochem. 2001 Jun;34(4):341-4
references.pmid: 11440737
references.citation: Am J Hematol. 1997 Nov;56(3):183-6
references.pmid: 9371532
references.citation: Parasitol Today. 1997 Jun;13(6):227-31
references.pmid: 15275075
references.citation: Ann Trop Paediatr. 2009 Dec;29(4):253-6
references.pmid: 19941747
references.citation: Am J Trop Med Hyg. 2009 Feb;80(2):194-8
references.pmid: 19190212
references.citation: Lancet. 2010 Nov 20;376(9754):1768-74
references.pmid: 20970179
references.citation: Am J Trop Med Hyg. 2010 Nov;83(5):981-9
references.pmid: 21036824
references.citation: Curr Opin Infect Dis. 2009 Oct;22(5):430-5
references.pmid: 19571748
references.citation: Southeast Asian J Trop Med Public Health. 1992 Mar;23(1):44-50
references.pmid: 1523477
references.citation: Indian J Pediatr. 2012 Apr;79(4):525-7
references.pmid: 21706239
references.citation: PLoS Med. 2008 Jun 17;5(6):e127
references.pmid: 18563961
references.citation: J Trop Pediatr. 2006 Feb;52(1):49-51
references.pmid: 15980019
references.citation: Trans R Soc Trop Med Hyg. 1997 May-Jun;91(3):256-62
references.pmid: 9231189