Biology Reference
In-Depth Information
1936
;
Dhayagude and Purandare, 1943
;
Tarejev et al., 1944
;
Boshes, 1947
;
Hill et al., 1963
;
Gopinathan and Subramaniam, 1982
;
Sachdev and Man,
1985
;
Arora et al., 1988
;
Valecha et al., 1992
;
Tilluckdharry et al., 1996
;
Beg et al., 2002
;
Ozen et al., 2006
;
Thapa et al., 2007
,
2009
;
Harish and
Gupta, 2009
;
Sarkar and Bhattacharya, 2008
;
Kasliwal et al., 2009
;
Parakh
et al., 2009
). Only studies in the past 15 years have been able to exclude
mixed species infection with
P. falciparum
by PCR methods (
Kochar
et al., 2005
,
2009
,
2010
;
Lampah et al., 2011
;
Tanwar et al., 2011
;
Beg
et al., 2002
;
Thapa et al., 2007
,
2009
;
Harish and Gupta, 2009
;
Sarkar and
Bhattacharya, 2008
;
Kasliwal et al., 2009
;
Parakh et al., 2009
). In Indone-
sian Papua, coma associated with PCR-confirmed
P. vivax
monoinfec-
tion (and without overt co-morbidities) occurred 23 times less frequently
than that seen with falciparum malaria and was estimated as occurring in
one in 29,500 infections (
Lampah et al., 2011
). In Thailand, the risk of
hospitalisation with impaired consciousness with microscopy-diagnosed
P. vivax
(not-PCR-confirmed) was one in 858 infections, with the risk
being 15.2-fold less than that with
P. falciparum
(
Luxemburger et al., 1997
).
Most other reports of coma in association with PCR-confirmed
P. vivax
monoinfection have been from the Indian sub-continent (
Kochar et al.,
2005
,
2009
,
2010
;
Tanwar et al., 2011
;
Beg et al., 2002
;
Thapa et al., 2007
,
2009
;
Harish and Gupta, 2009
;
Sarkar and Bhattacharya, 2008
;
Kasliwal
et al., 2009
;
Parakh et al., 2009
); however, denominators of the surveil-
lance and population-based risks were not reported. Only one case with
no identified alternative aetiology has been reported from South America,
a PCR-confirmed
P. vivax
monoinfection (
Lacerda et al., 2012
).
No series, including those with PCR-confirmed
P. vivax
monoinfection,
has reported complete, systematic microbiological and radiological investi-
gations to exclude bacterial and viral infection and other causes of coma.
Such studies are needed. In falciparum malaria, 23% of
P. falciparum
infection
meeting the WHO clinical case definition for cerebral malaria had an alter-
native cause of coma at autopsy (
Taylor et al., 2004
). In a prospective series
of 24 cases of coma associated with
P. vivax
infection diagnosed by micros-
copy, 75% had PCR evidence of
P. falciparum
(co)infection or other bacterial
or non-infective causes of coma; almost all PCR-confirmed cases of coma
in
P. vivax
monoinfection in this series were in young adults with low para-
sitaemia, no other organ dysfunction and good outcomes (
Lampah et al.,
2011
).
Plasmodium vivax
-associated coma has been associated with throm-
botic thrombocytopenic purpura in some (
Sinha et al., 2012
) but not other
(
Lampah et al., 2011
) series. Other adult series with
P. vivax
monoinfection
