Retinal haemorrhage: an unusual presentation of vivax malaria (original) (raw)
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Retinopathy of vivax malaria in adults and its relation with severity parameters
Pathogens and Global Health, 2016
Malarial retinopathy is a set of retinal signs in severe malaria due to falciparum malaria. With increased recognition of severe manifestations of vivax malaria, a systematic study to evaluate retinal changes in vivax malaria could elaborate our knowledge about this neglected entity. This observational study included retinal examination of 104 adult patients (>14 years) with varying severity of vivax malaria admitted to a tertiary care center during peak seasons of 2012 and 2013. Thirty-eight percent of severe cases had a retinal sign as compared to 6% of nonsevere cases (p < 0.01). No statistically significant effect of residence or age on the presence of retinopathy was noted. Females were found to be more prone to develop a retinal sign (p < 0.01). Presence of retinal signs was significantly associated with anemia and jaundice. No statistical association was noted for retinal signs to be present in either renal dysfunction or altered thrombocytes count. The most common signs were arteriovenous changes, present in eight cases (19%) of severe malaria and three cases (5%) of non-severe malaria. Retinal hemorrhage was present in five cases (12%) of severe malaria and no case of non-severe malaria. Both superficial and deep hemorrhages were seen including white-centered hemorrhages. Other signs included cotton wool spots, hard exudates, blurred disk margins with spontaneous venous pulsations and bilateral disk edema. A correlation between retinal signs and severity parameters was drawn from the study. This is the first systemic study to evaluate the retinal changes in vivax malaria. Larger prospective studies should be done for further knowledge regarding retinal changes in vivax malaria, especially severe disease. Apart from its clinical significance, it might lead to a better understanding of the pathogenesis of the systemic disease of vivax malaria.
Acta Tropica, 2011
Introduction: Despite the high prevalence of Plasmodium vivax (P vivax) malaria, research into its complications has lagged disproportionately as compared to Plasmodium falciparum (P falciparum) malaria. Material and methods: The present retrospective observational study was conducted on cases with P vivax mono-infection presenting with severe malaria on the basis of one or more criteria as per the World Health Organization guidelines being used for severe falciparum malaria in children, as well as other manifestations been classified as complicated malaria, during an outbreak of malaria in a single tertiary referral hospital of north India. Results: Seventy-four patients of acute malaria presented during the outbreak, of which 50 cases with P vivax mono-infection were included for the study. Complicated malaria was diagnosed in 41/50 cases, with thrombocytopenia being the commonest manifestation. Other presentations of severe malaria in our patients were liver dysfunction (with or without jaundice) 31/50 cases, respiratory involvement 14/50 cases, renal impairment 11/50 cases, circulatory collapse (Shock) 8/50 cases, severe anaemia 3/50 cases and central nervous system (CNS) involvement 2/50 cases. Conclusion: The term "benign tertian malaria" no longer holds true for P vivax mono-infection. The authors wish to open a new front for researches on the possible genotypic abnormalities that the parasite or its carrier might have acquired over decades and has transformed into a species with the malignant potential of P falciparum.
Vivax malaria presenting with cerebral malaria and convulsions
Acta Parasitologica, 2010
A patient was admitted with fever, vomiting, restlessness and convulsions. He was febrile and unconscious. Laboratory tests showed a low platelet count and ruled out enteric fever and dengue. His peripheral blood smear was positive for Plasmodium vivax. The presence of P. vivax monoinfection was confirmed by polymerase chain reaction and DNA sequencing. The report highlights the importance of considering the possibility of complications even in P. vivax malaria and formulation of strategies accordingly.
Severe Vivax Malaria: Newly Recognised or Rediscovered
PLoS Medicine, 2008
M alignant tertian" and "benign tertian" are terms that have long been used for two of the major diseases we recognise as malaria. The former is generally considered to be synonymous with Plasmodium falciparum and the latter with P. vivax infection. As the names "malignant" and "benign" suggest, the current dogma is that P. falciparum can be severe and life-threatening while P. vivax tends to be mild. However, two studies published in this issue of PLoS Medicine challenge this dogma.
Ophthalmology, 1996
Clinical and histopathologic findings of ocular lesions in malaria rarely have been described. This study reports lesions in three patients with malaria, with a histopathologic study of eyes obtained at autopsy of one of these patients. Methods: Various ocular lesions were documented in three patients with malarial infection, with histopathologic study of one patient. In all three patients, the diagnosis of malaria was confirmed by the demonstration of malarial parasites in peripheral smears and by fluorescent microscopy of acridine orange-stained buffy coat preparations of venous blood. Results: Multiple superficial blotchy retinal hemorrhages over the posterior pole were seen in the first patient, whereas acute bilateral panuveitis and secondary glaucoma were seen in the second, which on resolution showed multiple blotchy superficial retinal hemorrhages with perivasculitis. The third patient had cerebral malaria and was found to have subconjunctival and retinal hemorrhages. This patient died of pulmonary thromboembolism, and the eyes were obtained at autopsy. On gross examination, there were multiple retinal hemorrhages in the posterior pole. Histopathologic study showed cytoadherence of parasitized erythrocytes as well as schizonts and gametocytes of Plasmodium vivax within the retinal and choroidal blood vessels. Conclusion: The authors' findings suggest that patients with unexplained blotchy retinal hemorrhages should be investigated for malarial infection, especially if they reside or have travelled in endemic areas.
Study of Clinical Features and Epidemiology of Complicated Vivax Malaria
International journal of research - granthaalayah, 2019
Severe and complicated malaria is defined by the World Health Organization Malaria Action Programme in June 19851 as the presence of one or more of the following conditions in a slide confirmed diagnosed case of malaria cerebral malaria, severe anemia, renal failure, pulmonary edema or adult respiratory distress syndrome, hypoglycemia, circulatory collapse or shock, spontaneous bleeding, repeated generalized convulsions, acidemia or acidosis, macroscopic hemoglobinuria, impairment of consciousness less marked than unarousable coma,, hyperparasitemia, jaundice, hyperpyrexia, and the presence of complicating or associated infections. However, severe anemia and thrombocytopenia that causes bleeding diatesis is produced by hemolysis, reduced cell deformity of parasitized and non-parasitized erythrocytes, increased splenic clearance, reduction of platelet survival, decreased platelet production, and increased splenic uptake of platelets. Though these changes can be produced by P. vivax and P. falciparum infection yet the complicated malaria has commonly been associated with P. falciparum infections.
Changes in clinical manifestations in children with vivax malaria
International Journal of Contemporary Pediatrics, 2015
Background: There is an increased concern about the increasing virulence of Plasmodium vivax. The disease which was associated with relatively benign illness previously, is now increasingly witnessed in severe forms and with complications. Therefore we decided to look at our data over last 13 years if there is an increasing trend with regard to severity and complications of vivax malaria. Methods: The data from 133 children with vivax malaria diagnosed with thick and thin smear over a period ranging from2011 to 2013. For the purpose of comparison, we divided the data into 3 time periods A, B & C respectively. The data was analyzed to see if there is an increase in severity of vivax malaria. Results: There was a general increase in incidence of complications in children with vivax malaria. Incidence of shock increased from 2.9% in time period A to 25.9% in time period B and 28.6% in time period C and the change was statistically significant. This increase was also observed in incidence of respiratory distress, acute lung injury, bleeding manifestations and disseminated intravascular coagulation. However none of these changes were statistically significant. There was no change in the incidence of cerebral malaria. Conclusions: There appears to be an increase in severity and complications in vivax malaria in children. Clinicians need to be aware of this trend while managing children with vivax malaria.
Changes in hematological manifestations in children with vivax malaria
International Journal of Contemporary Pediatrics, 2015
INTRODUCTION Vivax malaria has long been considered to have a benign course with frequent relapses. However the recent evidence from all over the world suggests that Plasmodium vivax malaria is clinically less benign than has been commonly believed. 1 Numerous reports of thrombocytopenia, anaemia, other haematological manifestations, cerebral malaria, shock, ARDS due to P. vivax mono-infections. With this observation, we planned a study to see if there is an increase in haematological abnormalities in vivax malaria over recent decade. METHODS The study was conducted in the department of paediatrics at Christian medical college & hospital, Ludhiana. It included a total of 133 children from both retrospective and prospective analysis of children ≤16 years who presented to our hospital with the primary diagnosis of vivax malaria. Only slide positive cases were included in the study. The Retrospective data was collected from May 2001 to December 2011 from the hospital records. The prospective part of study involved evaluation, investigation, treatment and following up of children with vivax malaria who came to our hospital between January 2012 to July 2013.
Emerging Infectious Diseases, 2005
We report 11 cases of severe Plasmodium vivax malaria in Bikaner (western India). Patients exhibited cerebral malaria, renal failure, circulatory collapse, severe anemia, hemoglobinurea, abnormal bleeding, acute respiratory distress syndrome, and jaundice. Peripheral blood microscopy, parasite antigen-based assays, and parasite 18s rRNA gene-based polymerase chain reaction showed the presence of P. vivax and absence of P. falciparum. P lasmodium vivax malaria is prevalent in many regions of the world. It accounts for more than half of all malaria cases in Asia and Latin America. Despite the high prevalence of disease caused by this parasite, research into its effects has lagged disproportionately (1).
The spectrum of retinopathy in adults with Plasmodium falciparum malaria
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2009
A specific retinopathy has been described in African children with cerebral malaria, but in adults this has not been extensively studied. Since the structure and function of the retinal vasculature greatly resembles the cerebral vasculature, study of retinal changes can reveal insights into the pathophysiology of cerebral malaria. A detailed observational study of malarial retinopathy in Bangladeshi adults was performed using high-definition portable retinal photography. Retinopathy was present in 17/27 adults (63%) with severe malaria and 14/20 adults (70%) with cerebral malaria. Moderate or severe retinopathy was more frequent in cerebral malaria (11/20, 55%) than in uncomplicated malaria (3/15, 20%; P = 0.039), bacterial sepsis (0/5, 0%; P = 0.038) or healthy controls (0/18, 0%; P < 0.001). The spectrum of malarial retinopathy was similar to that previously described in African children, but no vessel discolouration was observed. The severity of retinal whitening correlated with admission venous plasma lactate (P = 0.046), suggesting that retinal ischaemia represents systemic ischaemia. In conclusion, retinal changes related to microvascular obstruction were common in adults with severe falciparum malaria and correlated with disease severity and coma, suggesting that a compromised microcirculation has important pathophysiological significance in severe and cerebral malaria. Portable retinal photography has potential as a valuable tool to study malarial retinopathy.