title: Plasmodium vivax hospitalizations in a monoendemic malaria region: severe vivax malaria?
abstract: Severe malaria caused by Plasmodium vivax is no longer considered rare. To describe its clinical features, we performed a retrospective case control study in the subregion of Luciano Castillo Colonna, Piura, Peru, an area with nearly exclusive vivax malaria transmission. Severe cases and the subset of critically ill cases were compared with a random set of uncomplicated malaria cases (1:4). Between 2008 and 2009, 6,502 malaria cases were reported, including 106 hospitalized cases, 81 of which fit the World Health Organization definition for severe malaria. Of these 81 individuals, 28 individuals were critically ill (0.4%, 95% confidence interval = 0.2-0.6%) with severe anemia (57%), shock (25%), lung injury (21%), acute renal failure (14%), or cerebral malaria (11%). Two potentially malaria-related deaths occurred. Compared with uncomplicated cases, individuals critically ill were older (38 versus 26 years old, P < 0.001), but similar in other regards. Severe vivax malaria monoinfection with critical illness is more common than previously thought.
authors.affiliation: Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Antonio M
authors.initials: AM
authors.lastname: Quispe
authors.affiliation: Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Edwar
authors.initials: E
authors.lastname: Pozo
authors.affiliation: Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Edith
authors.initials: E
authors.lastname: Guerrero
authors.affiliation: Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Salomón
authors.initials: S
authors.lastname: Durand
authors.affiliation: Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: G Christian
authors.initials: GC
authors.lastname: Baldeviano
authors.affiliation: Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Edgel
authors.affiliation: Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Paul C F
authors.initials: PC
authors.lastname: Graf
authors.affiliation: Department of Parasitology, US Naval Medical Research Unit No. 6 (NAMRU-6), Lima and Iquitos, Peru; Sub-Regional Epidemiology Office, Peruvian Ministry of Health, Piura, Peru; Bellavista Health Center, Peruvian Ministry of Health, Piura, Peru; Universidad Peruana Cayetano Heredia, Lima, Peru willy.lescano@med.navy.mil.
authors.forename: Andres G
authors.initials: AG
authors.lastname: Lescano
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000175:diagnosis / Q000209:etiology / Q000469:parasitology / Q000473:pathology*; D001921:Brain / Q000469:parasitology / Q000473:pathology; D016022:Case-Control Studies; D002675:Child, Preschool; D016638:Critical Illness; D019353:Endemic Diseases; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D055370:Lung Injury / Q000175:diagnosis / Q000209:etiology / Q000469:parasitology / Q000473:pathology*; D016780:Malaria, Vivax / Q000150:complications / Q000175:diagnosis / Q000469:parasitology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010568:Peru; D010966:Plasmodium vivax / Q000472:pathogenicity; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000209:etiology / Q000469:parasitology / Q000473:pathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012769:Shock / Q000175:diagnosis / Q000209:etiology / Q000469:parasitology / Q000473:pathology*
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