Complications of vivax malaria in Uttarakhand, India

S. P. Singh, Ragini Singh, Niaz Ahmad


Background: Malaria is an important cause of mortality and morbidity in India. Many recent studies have shown that vivax malaria which was once thought to be a benign condition has emerged in a more virulent form causing many cases of severe malaria and life threatening complications. There is paucity of data on this topic from this region.

Objective: The present study was conducted to find out the clinical features, complications, response to treatment and outcome of patients suffering from vivax malaria. The study has also tried to find out severe malaria associated with P. vivax infection.

Methods: The study was performed at SGRR Institute of Medical & Health Sciences, Dehradun, which is a tertiary care hospital of Uttarakhand. The study period was of two years, from September 2011 to August 2013. Patients of 18 years of age or above it who were smear positive or antigen positive were included in the study. All such patients who were admitted in the hospital underwent detailed clinical examination and investigation.

Results: Plasmodium vivax infection was identified in 140 patients. Splenomegaly, hepatomegaly, and hepatosplenomegaly, were common findings. Renal, hepatic and cerebral dysfunctions were noted. Severe malaria was observed in 63(45.0%). Thrombocytopenia was the commonest hematological abnormality. Mortality was seen in 9(6.4%) patients. Cerebral malaria, shock and ARDS were associated with high mortality and poor outcome.

Conclusion: Vivax malaria may cause life threatening complications. The complications of vivax malaria are similar to those which have been traditionally described with falciparum malaria.


Vivax malaria, Complications, Uttarakhand

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World Health Organization, World Malaria Report 2012, fact sheet, Available at Accessed on 5 August 2013.

Basu S, Gupta P. Malaria. In: Ghai OP, Gupta P, editors. Text book of Social and Preventive Medicine. 3rd ed. New Delhi: CBS Publisher and distributors, 2010:214-30.

Li J et al., Geographic Subdivision of the Range of the Malaria Parasite, Plasmodium vivax. Emerging Infectious Diseases, Centers for Disease Control and Prevention, Vol. 7, No. 1, Jan- Feb 2001.

Price RN, Douglas NM, Anstey NM. New developments in Plasmodium vivax malaria: severe disease and the rise of chloroquine resistance. Current Opin Infect Dis. 2009 Oct; 22(5):430-5.

Severe falciparum malaria. World Health Organization, Communicable disease clusture. Trans R Soc Trop Med Hyg. 2000; 94:S1- 90.

Williams TN, Maitland K, Phelps L, Bennett S, Peto TE, Viji J, Timothy R, Clegg JB, Weatherall DJ, Bowden DK. Plasmodium vivax: a cause of malnutrition in young children. QJM. 1997;90:751–757.

Beg MA, Khan R, Baig SM, Gulzar Z, Hussain R, Smego RA Jr. Cerebral involvement in Benign tertian malaria. Am J Trop Med Hyg. 2002; 67:230–232.

Genton B, D’Acremont V, Lorry K, Baea K, Reeder JC, Mueller I. Plasmodium vivax is associated with severe malaria in Papua New Guinean children. 54th Annual Meeting- American Society of Tropical Medicine and Hygiene; Washington, DC. 2005.

Kochar DK, Saxena V, Singh N, Kochar SK, Kumar SV, Das A. Plasmodium vivax malaria. Emerg Infect Dis. 2005; 11:132–134.

Picot S, Is P. Vivax still a paradigm for uncomplicated malaria? Med Mal Infect 2006; 36: 406-13.

Price RN, Tjitra E, Guerra CA. Vivax malaria: neglected and not benign. Am J Trop Med Hyg. 2007; 77(6 suppl):79-87.

Looareswan S, DavisJG, Allen DL et al. Thrombocytopenia in malaria. Southeast asian J Trop Med Public Health 1992;23:44-50.

Kumar A, Shashirekha. Thrombocytopenia - an indicator of acute vivax malaria. Ind J Patho Microbiol 2006;49:505-8.

Kakar A, Bhoi S, Prakash V, Kakar S. Profound thrombocytopenia in plasmodium vivax malaria. Diagn Microbiol Infect Dis 1999; 3593:243- 4.

Anju Aggarwal, Suman Rath, Shashiraj. Plasmodium vivax malaria presenting with severe thrombocytopenia (case report). J Trop Pediatr 2005; 51:120-1.

Lipin Prasad, Sujathan, Ajith K. Isolated Plasmodium Vivax Malaria associated thrombocytopenia (case report). Clin Biochem 2001; 34:341-4.

Rodriguez-Morales AJ, Sanchez E, Vargas M. Occurrence of thrombocytopenia in Plasmodium vivax malaria. Clin Infect Dis 2005; 41:130-1.

Limaye CS, Londhey V A, Nabar S T. The study of complications of vivax malaria in comparison with falciparum malaria in Mumbai. J Assoc Physicians India 2012; 60:15-18.

Jadhav UM, Patkar VS, Kadam NN. Thrombocytopenia in malaria: correlation with type and severity of malaria. J Assoc Physicians India 2004; 52:615-8.

McKenzie FE, Prudhomme WA, Magill AJ et al. White blood cell counts and malaria. J Infect Dis 2005; 192:323-30.

Jadhav UM, Singhvi R, Shah R. Prognostic implications of white cell differential count and white cell morphology in malaria. J Postgrad Med 2003; 49:218-21.

Acute renal failure in Plasmodium vivax malaria. Prakash J, Singh AK, KumarNS, Saxena RK. J Assoc Physcian India. 2003 Mar; 51:265-7.

Akinosoglo KS, Solomou EE, Gogo CA. Malaria: A hematological disease. Hematology. 2012 Mar;17(2):106-14.

Sharma V, Samant R, Hegde A, Bhaja K. Autoimmune hemolysis in malaria: a report of 3 cases J Assoc Physicians India 2012 Feb ;60:129-31.