Biology Reference
In-Depth Information
4. CLINICAL ILLNESS REQUIRING HOSPITALISATION
Whilst most infections are uncomplicated, this does not imply that
P. vivax is benign (see Price et al., 2007b , 2009 ; Baird, 2009 ; Bassat and
Alonso, 2011 for reviews). In vivax-endemic countries, infection with
P. vivax can account for up to 40% of patients hospitalized with malaria,
including 17% (34/204) of all hospital malaria admissions in Vanuatu
( Maitland et al., 1997 ), 38% (382/1000) in Manila ( Buck et al., 1983 ),
32% (237/740) in northeast India ( Gopinathan and Subramanian, 1986 )
and 24% (1002/4140)-31% (799/2537) in western Thailand ( Carrara
et al., 2006 ). In Papua, Indonesia, P. vivax accounted for 24% of malaria
admissions in all age groups, but 47% (415/887) are children under
1 year of age ( Tjitra et al., 2008 ). In Papua, the risk of illness requir-
ing hospitalisation has been estimated at 1 in 84 infections with P. vivax
(Douglas et al., unpublished). The need for hospitalization indicates at
least moderately severe disease and significant morbidity. This includes
patients with vomiting, who cannot tolerate oral therapy, through to
prostration and those with disease manifestations fulfilling the severity
criteria used to define severe falciparum malaria ( World Health Organi-
zation, 2010 ) as outlined below.
5. SEVERE MALARIA
Plasmodium vivax was recognized in the malariotherapy era as
being associated with significant risk of death, with 5-10% of patients
with neurosyphilis dying during P. vivax therapy ( Swellengrebel and de
Buck, 1938 ; Fong, 1937 ; O'Leary and Welsh, 1933 ; James et al., 1936 ;
Paulian, 1935 ; Nicol, 1932 ; Eldridge et al., 1925 ; Freeman et al., 1934 )
and up to 10-14% with the Madagascar strain ( James, 1933 ) (reviewed
in detail in Chapter 5). Early descriptions of severe disease in naturally
acquired vivax malaria were confined to case reports and small case series
(see Price et al., 2007a ; Tan et al., 2008 for reviews), but more recently,
larger series have clearly associated P. vivax infections with severe and
fatal disease in both children and adults ( Barcus et al., 2007 ; Rodriguez-
Morales et al., 2008 ; Tjitra et al., 2008 ; Kochar et al., 2005 , 2009 , 2010 ;
Andrade et al., 2010 ; Alexandre et al., 2010 ; Yadav et al., 2012 ; Lacerda
et al., 2012 ; Nurleila et al., 2012 ; Manning et al., 2011 ; Lanca et al.,
2012 ; Kaushik et al., 2012 ; Sharma et al., 2012 ; Naha et al., 2012 ).
These series highlight substantial morbidity, particularly severe anaemia
 
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