Biology Reference
In-Depth Information
In most series, AKI is commonly associated with multiorgan dysfunc-
tion (
Kochar et al., 2005
,
2009
;
Andrade et al., 2010
;
Kute et al., 2012b
),
and is a risk factor for fatal outcome (
Kute et al., 2012b
). Shock is also
a common association (
Kochar et al., 2005
,
2009
;
Andrade et al., 2010
;
Alexandre et al., 2010
;
Kute et al., 2012b
). Renal biopsies in four patients
with vivax-associated AKI reported patchy cortical necrosis in three cases
and acute tubular necrosis in the other (
Kute et al., 2012b
). The presenta-
tions reported frequently mimicked AKI seen with sepsis and/or shock,
but since investigation for bacterial sepsis was not universal, the role of
concomitant bacterial sepsis as a contributor to these syndromes cannot
be excluded. Furthermore, in the largest autopsy series of deaths associ-
ated with
P. vivax
infection, all six cases with AKI were associated with
pre-existing co-morbidities predisposing to AKI or multiorgan dysfunc-
tion (heart failure, sickle cell haemolytic crisis and chronic liver disease) or
alternative aetiologies (primaquine-triggered haemolysis or yellow fever)
(
Lacerda et al., 2012
).
Other
P. vivax
series have reported AKI associated with thrombotic micro-
angiopathy (
Sinha et al., 2012
;
Saharan et al., 2008
) in both adults and children,
and haemolytic uraemic syndrome (HUS) in children (
Sharma et al., 1993
). In
the largest series to date (4 adults and 5 children), persistent vivax-associated
AKI was associated with thrombocytopenia (range 8,000-82,000/µl) and
anaemia (Hb 4.4-9.6), with schistocytes on peripheral film in 77% (
Sinha
et al., 2012
). Bleeding manifestations (77%) and splenomegaly (44%) were
common, with one of the patients with schistocytes having concomitant
coma (
Sinha et al., 2012
). Biopsies showed universal ischaemia and endo-
thelial injury and arteriolar thrombi in two cases, consistent with thrombotic
microangiopathy (
Sinha et al., 2012
). Fatal AKI associated with crescentic glo-
merulonephritis has also been reported in
P. vivax
infection (
Patel et al., 2012
).
8.1.5. Shock and multiorgan dysfunction
Shock has been associated with adult
P. vivax
infection in reports and series
from India, Brazil, Malaysia and Korea (
Kochar et al., 2005
,
2009
;
Alexandre
et al., 2010
;
Song et al., 2007
; Barber et al., 2012) usually, but not always
(Barber et al., 2012), as part of multiple organ dysfunction (
Kochar et al.,
2005
,
2009
;
Andrade et al., 2010
;
Alexandre et al., 2010
). These clinical syn-
dromes are also seen with severe bacterial sepsis, raising the possibility of
bacterial co-infection in these patients. The aforementioned cases and series
did not describe universal, systematic surveillance with culture of blood and
other fluids.
