Biology Reference
In-Depth Information
study has assessed the impact of co-infection with gastrointestinal helminths
on the anaemia of vivax malaria in children.
Melo et al. (2010)
showed
that in the Western Brazilian Amazon, co-infection with hookworm,
Ascaris
lumbricoides
and
Trichuris trichiura
, actually attenuated the reduction in hae-
moglobin associated with vivax malaria.
8.2.2. Respiratory distress
Respiratory distress is a common severe manifestation in most series of
severe paediatric vivax malaria (
Tjitra et al., 2008
;
Kochar et al., 2010
;
Yadav et al., 2012
;
Genton et al., 2008
). As in adults, the definitions used for
respiratory distress vary considerably between series (
Taylor et al., 2012
),
complicating comparison. Respiratory distress occurred more frequently in
vivax malaria (60%) than in falciparum malaria (41%) (
Genton et al., 2008
)
in Papua, New Guinean children. These rates were substantially higher than
those reported in hospitalised children in Papua, Indonesia, a reflection of
the broader inclusion criteria in PNG. In the Papua study, rates were similar
between
P. vivax
(2.3%) and
P. falciparum
(2.5%) (
Tjitra et al., 2008
). In a
study from Rajasthan, India, respiratory distress was more frequent in chil-
dren with falciparum malaria (18%) than those with vivax malaria (11%),
however, this ratio was reversed in young children of age <5 years (2% and
15% respectively) (
Kochar et al., 2010
).
Both hypoxemia and metabolic acidosis have been described in children
with vivax-associated respiratory distress (
Kochar et al., 2010
). Metabolic
acidosis (
Marsh et al., 1995
;
Miller et al., 2002
), community-acquired pneu-
monia (
O'Dempsey et al., 1993
), aspiration pneumonia, sepsis and severe
anaemia are important factors in respiratory distress in children with falci-
parum malaria (
Taylor et al., 2012
), but their relative contribution to the
respiratory distress associated with
P. vivax
is unclear. Two of 24 children in
a Delhi series of severe vivax malaria had respiratory distress and two were
reported to have lobar pneumonia, though whether these were the same
patients was not specified (
Kaushik et al., 2012
). Of 24 children admitted to
an intensive care unit in Brazil with severe disease associated with
P. vivax
infection, respiratory distress was the commonest complication (
n
= 16;
67%). Three of these (12.5% overall) children were reported to have strictly
defined ARDS (
Lanca et al., 2012
); none died. One of the patients with
respiratory distress (6%) had pneumonia and empyema identified as the
cause of respiratory distress (
Lanca et al., 2012
). One of the 65 cases of
PCR-confirmed severe vivax cases from Rajasthan had pulmonary oedema
in association with multiorgan dysfunction (
Kochar et al., 2010
).