title: Imported Plasmodium vivax malaria with severe thrombocytopaenia: can it be severe malaria or not?
abstract: BACKGROUND
  Thrombocytopaenia is the most frequent malaria-associated haematologic alteration observed with all five Plasmodium parasites causing disease in humans. Although not included in the World Health Organization criteria for severe Plasmodium falciparum malaria, severe thrombocytopaenia has been increasingly mentioned as an indicator of P. vivax malaria severity.
  
  
  METHODS
  Here, it is described a case of imported P. vivax malaria in a 37-year old man from Pakistan who presented with severe thrombocytopaenia (5 × 10(9)/L). He was admitted to the intensive care unit and initially treated with a 1-day course of intravenous quinine followed by oral chloroquine and primaquine. The patient's platelet count increased as early as 4 hours after treatment inception and the clinical course was favourable and uneventful.
  
  
  CONCLUSIONS
  This case report, along with a review of published cases focusing on the relationship between thrombocytopaenia and severe P. vivax malaria, suggests that the prognostic role of severe thrombocytopaenia is ambiguous in absence of severe haemorraghic complications and its use as diagnostic criterion of malaria severity may lead to overestimation of severe P. vivax malaria cases.
  
  
  CONCLUSIONS
  Due to the lack of high quality studies it is at present unclear if severe thrombocytopaenia in the setting of P. vivax malaria should be considered indicative of severe malaria.
authors.affiliation: Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy. spinello.antinori@unimi.it.
authors.forename: Spinello
authors.initials: S
authors.lastname: Antinori
authors.affiliation: Intensive Care Unit Luigi Sacco Hospital, Milan, Italy. corona.alberto@hsacco.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Corona
authors.affiliation: Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy. annalisa.ridolfo@unimi.it.
authors.forename: Anna Lisa
authors.initials: AL
authors.lastname: Ridolfo
authors.affiliation: Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy. galimberti.laura@hsacco.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Galimberti
authors.affiliation: Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy. davide.ricaboni@unimi.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Ricaboni
authors.affiliation: Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy. laura.milazzo@unimi.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Milazzo
authors.affiliation: Department of Clinical and Biomedical Sciences Luigi Sacco, III Division of Infectious Diseases, University of Milano, Via GB Grassi, 74, 20157, Milan, Italy. mario.corbellino@unimi.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Corbellino
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D006801:Humans; D007558:Italy; D016780:Malaria, Vivax; D008297:Male; D010154:Pakistan / Q000208:ethnology; D010966:Plasmodium vivax; D011803:Quinine / Q000627:therapeutic use; D013921:Thrombocytopenia
chemical_list: D000962:Antimalarials; D011803:Quinine