Biology Reference
In-Depth Information
8.1.8. Thrombocytopenia
Although not a defining feature of severe malaria, vivax-associated throm-
bocytopenia occurs in 24-94% of patients with vivax malaria (see
Tan et al.,
2008
;
Lacerda et al., 2011
for reviews). It has been associated with other
severe manifestations (
Kochar et al., 2005
,
2009
;
Andrade et al., 2010
;
Alexandre et al., 2010
). In one series, severe epistaxis associated with throm-
bocytopenia requiring blood and platelet transfusions was reported in 5%
(2/40) of adults with severe vivax malaria (
Kochar et al., 2009
).
8.1.9. Other complications
Jaundice is common, occurring in 36-57% of adults in severe vivax series,
and has been associated with multiorgan dysfunction (
Kochar et al., 2005
,
2009
;
Andrade et al., 2010
;
Alexandre et al., 2010
). Acalculous cholecys-
titis has been described in adults (
Curley et al., 2011
) with gall bladder
wall oedema and periportal oedema described in 32% and 35%, respec-
tively, of 34 vivax malaria patients undergoing CT scanning for abdominal
pain (
Kim et al., 2010
). Series from the 1940s have reported patients with
acute lower abdominal pain associated with vivax malaria, but not with
splenomegaly, mimicking appendicitis and other acute surgical conditions
(
Kitchen, 1949b
;
Most and Hayman, 1946
). Another rarely reported com-
plication is rhabdomyolysis (
Siqueira et al., 2010
).
8.2. Severe Malaria in Children
Most of the severe manifestations seen in children with
P. falciparum
malaria
have also been reported in children with
P. vivax
.
8.2.1. Severe anaemia
In regions with high transmission of
P. falciparum
, severe anaemia is the
most common manifestation of severe falciparum malaria in children, with
falciparum-associated severe anaemia being rare beyond childhood (
Bloland
et al., 1999
). In Kilifi, Kenya, severe anaemia was the most common manifes-
tation of severe falciparum malaria in children admitted to hospital between
1989 and 1991 (27.5%) and was associated with a 4.7% case fatality (
Marsh
et al., 1995
). Similarly, in paediatric vivax malaria, the major severe mani-
festation in most series is severe anaemia (
Rodriguez-Morales et al., 2008
;
Tjitra et al., 2008
;
Alexandre et al., 2010
;
Kochar et al., 2010
;
Poespoprodjo
et al., 2009
;
Luxemburger et al., 1997
). However, none of these reports
describe the confounding effects of other co-factors. They are also almost
all cross-sectional surveys, and thus are unable to quantify the decrement in
