title: Clinical manifestations and molecular mechanisms in the changing paradigm of vivax malaria in India.
abstract: BACKGROUND
  Plasmodium vivax once considered benign is now being increasingly associated with complicated malaria where the spectrum of complications is vast and like Plasmodium falciparum. The clinical data is important with respect to the immunopathological status of the patient. Several genes like the vir genes and pvcrt-o are speculated to be attributing to the severity of P. vivax malaria.
  
  
  METHODS
  In the present study we carried out the transcription analysis of five vir genes (vir 14-related, vir 12, vir 17-like, putative vir 14 and vir 10-related) and pvcrt-o gene in severe (n=12) and non-severe (n=7) P. vivax clinical infections and studied the correlation of these genes with clinical disease severity.
  
  
  RESULTS
  This study revealed multiorgan involvement in severe vivax cases with severe thrombocytopenia and anemia, the predominantly occurring symptoms. Four out of five vir genes and pvcrt-o showed a significant increase in expression levels of severe infections compared to the non-severe infections indicating their possible role in the changing pathogenesis of P. vivax.
  
  
  CONCLUSIONS
  The increased virulence in vivax malaria seems to be the result of multifactorial parameters changing it phenotypically as well as genotypically. However more studies are needed to understand the still nascent severity of P. vivax malaria.
authors.affiliation: National Institute of Malaria Research (ICMR), Sector-8, Dwarka, New Delhi 110077, India.
authors.forename: Purva
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi 110001, India.
authors.forename: Rajni
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi 110001, India.
authors.forename: Jagdish
authors.initials: J
authors.lastname: Chandra
authors.affiliation: Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi 110001, India.
authors.forename: Virender
authors.initials: V
authors.lastname: Kumar
authors.affiliation: National Institute of Pathology (ICMR), Safdarjung Hospital Campus, New Delhi 110029, India.
authors.forename: Ruchi
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Biotechnology, Kumaun University, Nainital 263001, Uttarakhand, India.
authors.forename: Veena
authors.initials: V
authors.lastname: Pande
authors.affiliation: National Institute of Malaria Research (ICMR), Sector-8, Dwarka, New Delhi 110077, India. Electronic address: vineetas_2000@yahoo.com.
authors.forename: Vineeta
authors.initials: V
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004912:Erythrocytes / Q000469:parasitology; D005260:Female; D015870:Gene Expression; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D016780:Malaria, Vivax / Q000175:diagnosis* / Q000453:epidemiology / Q000469:parasitology*; D008297:Male; D010966:Plasmodium vivax / Q000502:physiology*; D015800:Protozoan Proteins / Q000235:genetics
chemical_list: D015800:Protozoan Proteins
keywords: P. vivax; Severe malaria; pvcrt-o gene; vir genes