Pulmonary complications of Plasmodium vivax malaria

Abstract

Plasmodium vivax malaria has historically been termed as benign tertian malaria. Several reports of P vivax malaria induced organ-specific complications have emerged in recent years. To study the clinical aspects of P vivax induced complications in patients admitted in a tertiary care hospital over a period of one year. The WHO's pre-defined criteria for complicated Falciparum malaria was used to define cases of P vivax associated complicated malaria A retrospective chart review was conducted at the Aga Khan University Hospital (AKUH). Medical records of all patients admitted in 2011 with the primary diagnosis of Malaria were retrieved to study the clinical presentation and outcomes. A total of 180 cases of malaria were admitted in 2011. Malaria was caused by P vivax in 147 cases (81.7%), P falciparum in 12 cases (6.7%) and Mixed in 21 cases(11.7%). Complications occured in 67 cases (37.2%) cases; caused by P vivax in 54 (80.6 %), P falciparum in 6 (9.0%) and mixed infection in 5 (7.5%). The overall mortality was 1.04%. Multiorgan dysfunction was more common as compared to single organ involvement. Pulmonary complications were present in 20 of 54 cases (37%) and include acute lung injury, acute respiratory distress syndrome, pulmonary edema and respiratory failure. In contrast, pulmonary involvement was not seen in P falciparum. Non invasive mechanical ventilation was required by 7 of 20 (35%) patients with pulmonary involvement and 5 of them later required invasive mechanical ventilation. Acute kidney injury, secondary bacterial infections, jaundice, thrombocytopenia, hyperpyrexia and severe anemia were other common complications with P vivax. Our study shows that P vivax is more frequent plasmodium specie causing serious disease.