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In-Depth Information
et al., 2012
) and was present in 54% of 24 children requiring ICU admission
in Brazil (
Lanca et al., 2012
). Many series are limited by incomplete systematic
investigation for bacterial sepsis and other potential co-morbidities. Although
one series described negative pre-antibiotic blood cultures among
P. vivax
-
infected patients with shock (
Lanca et al., 2012
), 38% of these had an identi-
fied additional infectious co-morbidity potentially contributing to shock.
8.2.6. Other manifestations
Jaundice is common in severe vivax malaria (
Alexandre et al., 2010
;
Kochar
et al., 2010
;
Lanca et al., 2012
;
Jat et al., 2012
), mostly in association with
other severe manifestations (
Lanca et al., 2012
). In Brazilian children, jaun-
dice did not predict need for ICU admission (
Lanca et al., 2012
). Hypo-
glycaemia (blood glucose <2.2 mmol/l or <40 mg/dl) (
World Health
Organization, 2010
) was found in 12.5% of children with vivax malaria
requiring admission to intensive care unit in Brazil (
Lanca et al., 2012
). Less-
common manifestations reported in association with
P. vivax
also include
haemoglobinuria in the absence of G6PD deficiency (
Kochar et al., 2010
),
acalculous cholecystitis (
Curley et al., 2011
), gangrene (
Raghunandan et al.,
2012
) and fatal pulmonary haemorrhage and haematemesis (
Jat et al., 2012
).
8.3. Vivax Malaria in Pregnancy
8.3.1. Effects on mother
In contrast to
P. falciparum
,
P. vivax
is not commonly associated with severe
malaria in pregnant women (
Nosten et al., 1999
;
Poespoprodjo et al., 2008
;
Rijken et al., 2012a
;
McGready et al., 2012a
,
2012b
) and in a large series
from the Thai-Burma border, no maternal deaths were associated with
vivax malaria over a 25-year period (
McGready et al., 2012b
). Despite
its rarity in large series from Thailand and Indonesia (
Nosten et al., 1999
;
Poespoprodjo et al., 2008
;
McGready et al., 2012a
), severe maternal malaria,
including severe anaemia, has been reported in association with
P. vivax
infection in small series from India (
Kochar et al., 2005
;
Nayak et al., 2009
)
with poor pregnancy outcomes but again with no maternal deaths. In all
endemic regions, vivax-associated maternal anaemia is common, being
approximately twice as likely in pregnant women infected with
P. vivax
than without (
Nosten et al., 1999
;
Poespoprodjo et al., 2008
).
8.3.2. Effects on foetus and neonate
Plasmodium vivax
infection in pregnancy causes a reduction in birth weight
(median 108 g) (
Nosten et al., 1999
;
Poespoprodjo et al., 2008
;
Rijken
