Biology Reference
In-Depth Information
with cough, dyspnoea and 'bronchitis' (
Falconer, 1919
;
Stirk, 1943
;
Hyman, 1945
). Cough, usually non-productive, occurs in approxi-
mately half of the adults with vivax malaria, in residents of both vivax-
endemic and -non-endemic areas (
Anstey et al., 2002
;
Anstey et al.,
2007
). Tachypnoea may occur because of high fever, anaemia and/or
pulmonary pathology (
Kitchen, 1949a
;
Taylor et al., 2012
). As with falci-
parum malaria (
O'Dempsey et al., 1993
), there is a clinical overlap with
symptoms suggestive of lower respiratory tract infection (
Hyman, 1945
;
Anstey et al., 2007
).
3.3. Malnutrition and Impaired Growth
In the pre-antibiotic era, untreated vivax malaria was associated with
chronic relapsing-remitting debilitating fevers, weight loss, cachexia, hypo-
proteinemia and oedema in adults and children (reviewed in
Dobson, 1997
;
Kitchen, 1949a
). In the antimalarial era, vivax malaria has also been clearly
associated with malnutrition in early childhood (
Williams et al., 1997
). A
longitudinal Peruvian study has recently shown that a single episode of
vivax malaria results in impaired weight gain and growth persisting for at
least 6 months, with greater deficits per incident episode than either diar-
rhoeal disease or non-specific febrile illness (
Lee et al., 2012
). The interac-
tion between
P. vivax
infection and malnutrition appears to be bidirectional.
As well as being caused by vivax malaria (
Lee et al., 2012
), malnutrition is
associated with increased risk of severe and fatal outcome in those infected
with
P. vivax
(Section
7
).
3.4. Impaired School Performance
Findings from Sri Lanka showed that acute malaria from either
P. vivax
or
P. falciparum
resulted in a median of 5.4 days school absenteeism per episode
of malaria (
Fernando et al., 2003b
). Furthermore, acute malaria was associ-
ated with significant impairment of cognitive performance, persisting for
at least 2 weeks after the febrile episode. This effect was greater than that
due to non-malarial fever and independent of confounding socioeconomic
factors. The effects were cumulative, with repeated attacks of malaria having
a greater adverse impact on school performance (
Fernando et al., 2003a
).
Similar findings have been reported from Brazil (
Vitor-Silva et al., 2009
).
In view of the relapsing nature of
P. vivax
and its propensity to occur in
children, the long-term social implications on education and development
could be substantial.
