Biology Reference
In-Depth Information
8.1.6. Bacterial co-infection and bacteraemia
Gram-negative bacteraemia is a common complication in severe falci-
parum malaria, particularly in children (
Berkley et al., 1999
;
Scott et al.,
2011
), and is a risk factor for death (
Berkley et al., 1999
). However,
bacteraemia risk in
P. vivax
infection has not been studied systemati-
cally. A large prospective blood culture and malaria microscopy study
in Kolkata, India showed that 2 of 90 (2.2%) cases of malaria (97% of
which were
P. vivax
) had
Salmonella
bacteraemia, one
Salmonella typhi
and one non-typhoidal
Salmonella
(
Sur et al., 2006
). Of the two cases
of
Salmonella
bacteraemia reported from Thailand in association with
PCR-confirmed
P. vivax
monoinfection, one patient had multiorgan
dysfunction (renal failure, jaundice and hypotension) meeting 2010 cri-
teria for severe malaria (
World Health Organization, 2010
), with con-
current serogroup D
Salmonella
bacteraemia (
Piyaphanee et al., 2007
).
The other otherwise-uncomplicated
P. vivax
case had non-typhoidal
Salmonella
bacteraemia (
Piyaphanee et al., 2007
). In Malaysia, five of 43
patients hospitalised with vivax malaria had hypotension and one had
Streptococcus pneumoniae
bacteremia (Barber et al., 2012).
8.1.7. Splenic rupture and infarction
Splenic rupture is a well-recognized, life-threatening but probably under-
reported complication of
P. vivax
infection in adults (
Lacerda et al., 2012
;
Kitchen, 1949a
;
Lubitz, 1949
;
Moses, 1945
;
Kapland et al., 1946
;
Imbert et al.,
2009
). In a systematic review of 55 cases of malaria-associated splenic rupture
reported over a 50-year period (1958-2008), the mortality rate was 22%, with
P. vivax
accounting for approximately half of all cases (
Imbert et al., 2009
). In
the 2012 Brazilian autopsy series of 17 patients with deaths associated with
P. vivax
, three patients (18%) had splenic rupture, all adults, two of whom also
had lung oedema (
Lacerda et al., 2012
). Of the four deaths considered directly
caused by
P. vivax
, splenic rupture was present in two (
Lacerda et al., 2012
).
Splenic infarction is thought to be rare in vivax malaria, though it is
also likely to be under-recognised and under-reported (
Gupta et al., 2010
;
Imbert et al., 2010
). Splenic infarction is not commonly associated with
splenic rupture, being found on histopathology in <2% of cases of splenic
rupture (
Imbert et al., 2009
). Although not necessarily causally linked to
symptoms, splenic infarction was identified in 38% of 34 Korean vivax
patients undergoing CT scanning for abdominal pain (
Kim et al., 2010
).
Splenic rupture or subcapsular haematoma was identified in a further 3
(9%) of these cases (
Kim et al., 2010
).
