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8.2.3. Coma
PCR-confirmed P. vivax monoinfection has also been associated with
coma in children ( Kochar et al., 2010 ; Lacerda et al., 2012 ; Lampah et al.,
2011 ; Tanwar et al., 2011 ; Thapa et al., 2007 , 2009 ; Harish and Gupta, 2009 ;
Parakh et al., 2009 ), however, exclusion of alternative aetiologies was not
possible. Two Brazilian children with vivax-associated coma underwent
autopsy, both 8-year-old females reported in two separate series ( Lacerda
et al., 2012 ; Lanca et al., 2012 ). In the first, the 2012 Manaus autopsy series,
one child with an inflammatory cerebrospinal fluid had no alternative cause
evident at autopsy but encephalitis was not excluded ( Lacerda et al., 2012 ).
The other child was admitted to intensive care in Manaus with microscopic
diagnosis of P. vivax with coma ( Lanca et al., 2012 ). The outcome was fatal,
however, autopsy revealed an underlying aetiology of viral encephalitis.
8.2.4. Renal dysfunction and acute kidney injury
AKI is less common and less severe among children with severe falciparum
malaria than in adults ( Dondorp et al., 2008 ; Hien et al., 1996 ; Anstey et al.,
1996 ; Weber et al., 1999 ). AKI, with varying definitions, has been reported
increasingly as a manifestation of severe vivax malaria in children ( Kochar
et al., 2010 ; Yadav et al., 2012 ; Manning et al., 2011 ; Kaushik et al., 2012 ; Jat
et al., 2012 ) occurring in 3-15% of severe cases in these series, usually as part of
multiorgan dysfunction. In paediatric series including both severe falciparum
malaria and severe vivax malaria, renal impairment occurred with a lower
( Kochar et al., 2010 ) or similar ( Yadav et al., 2012 ; Manning et al., 2011 ) fre-
quency in those with P. vivax infection. Mortality rates of up to 30% have been
reported in children with PCR-confirmed P. vivax monoinfection-associated
AKI, all of whom had associated multiorgan dysfunction ( Kochar et al., 2010 ).
The majority (77%) of reports of AKI secondary to P. vivax -associated
thrombotic microangiopathy ( Sinha et al., 2012 ; Saharan et al., 2008 ) and
HUS ( Sharma et al., 1993 ) have occurred in children. Nephrotic syn-
drome, more commonly associated with mesangioproliferative and mem-
branoproliferative glomerulonephritis from Plasmodium malariae ( Gilles and
Hendrickse, 1963 , 1960 ; van Velthuysen and Florquin, 2000 ), has also been
more recently described in association with P. vivax in children ( Bircan et al.,
1997 ; David et al., 2009 ).
8.2.5. Shock and multiorgan dysfunction
Shock has been described in several series of children with vivax malaria,
often associated with multiorgan dysfunction ( Kochar et al., 2010 ; Kaushik
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