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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 ).
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