title: Severity of Plasmodium vivax malaria in Karachi: a cross-sectional study.
abstract: BACKGROUND
  Plasmodium vivax malaria affects billions of people annually. This study aimed to note the presentations and complications and subsequently to identify the determinants of in-patient hospital care of P. vivax malaria patients presenting to a tertiary care hospital in Karachi, Pakistan. Severity of the shock was also assessed using a shock index.
  
  
  METHODS
  This study descriptive cross-sectional study was conducted at the Emergency Department of Aga Khan University Hospital, Karachi. All adult patients with a positive P. vivax peripheral film and/or immunochromatography admitted through the department were studied during 2009. Data was entered and analyzed using SPSS version 16. Keeping the length of stay at a cut-off of 48 hours after admission, the independent Student-t test was applied. Level of significance was taken at 0.05.
  
  
  RESULTS
  A total of 97 patients were included in the study. Fever was the most common presentation. A significant number of patients had nonspecific complaints, but tachycardia, altered mental status, and adult respiratory distress syndrome were important findings. Mean shock index was 1 (SD 0.26). Common reasons for admission were thrombocytopenia and dehydration. Some patients were admitted for more than 48 hours. Complications included pneumonia and bleeding requiring platelet transfusion.
  
  
  CONCLUSIONS
  This study highlights that the debilitating impact of P. vivax malaria remains high. Although the effects of severe vivax malaria can be contained through aggressive resuscitation and specific therapy, sensitivity and awareness of this complicated course must be highlighted among caregivers.
authors.affiliation: Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan. amber.mehmood@aku.edu
authors.forename: Amber
authors.initials: A
authors.lastname: Mehmood
authors.forename: Kiran
authors.initials: K
authors.lastname: Ejaz
authors.forename: Tauqeer
authors.initials: T
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D016780:Malaria, Vivax / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D012128:Respiratory Distress Syndrome / Q000453:epidemiology; D013610:Tachycardia / Q000453:epidemiology; D062606:Tertiary Care Centers