Hemophagocytic syndrome in Plasmodium vivax malaria (original) (raw)
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Journal of vector borne diseases, 2013
Hemophagocytic syndrome (HPS) is a reactive disorder of the mononuclear phagocytic system, characterized by benign, generalized histiocytic proliferation, with marked hemophagocytosis in bone marrow 1 . Generally, HPS has been related with hematologic diseases, autoimmune diseases, or with various infections 1 . There are plenty of reports on hemophagocytic syndrome associated with Plasmodium falciparum monoinfetion 2-9 , but reports on the association with P. vivax monoinfection are very scanty 9-14 . In most of these case reports, the diagnosis was made by peripheral blood smear (PBS) and rapid diagnostic test (RDT) without molecular diagnostic confirmation. Thus, there are always chances of species misidentification and missing the mixed infection thereby lacking authenticity. In this case report, the species diagnosis was confirmed by polymerase chain reaction (PCR) and possibilities of other diseases were ruled out by stringent laboratory and biochemical investigations to establish the firm association of hemophagocytic syndrome with P. vivax monoinfection.
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.
Anemia and Thrombocytopenia in Children with Plasmodium vivax Malaria
Journal of Tropical Pediatrics, 2006
Clinico-epidemiological features of pediatric patients with malaria due Plasmodium vivax that developed anemia and thrombocytopenia requiring hospitalization are herein reported. Over a 3-year period, 78 children with P. vivax infection were admitted to our Hospital in Sucre, Venezuela. Clinical manifestations at admission were 93.59 per cent fever, 41.03 per cent chills and 14.10 per cent headache, among others. On paraclinical evaluations 94.87 percent presented with anemia (10.26 per cent severe), 25.64 percent with malnutrition, and 10.26 percent had intestinal parasitosis. The mean hemoglobin levels on admission were 8.09 g/dl and mean platelet counts 127 402 cells/mm 3. Among these patients 58.97 per cent developed thrombocytopenia (24.36 per cent severe) requiring transfusion in 25.64 per cent of patients. After antimalarial treatment with chloroquine and primaquine and supportive care all patients were successfully discharged. No deaths or further complications were seen, except for persistent mild thrombocytopenia in 17.95 per cent of the patients.
A case of hemophagocytic syndrome as a complication of <i>Plasmodium</i> vivax malaria
Open Journal of Clinical Diagnostics, 2013
Hemophagocytic lymphohistiocytosis syndrome (HPS) is a potentially fatal hyperinflammatory response characterized by a generalized histiocytic proliferation with marked hemophagocytosis in bone marrow [1]. Hemophagocytic syndrome has been associated with genetic mutations, autoimmune diseases, hematological malignancies or infections [2,3]. According to the data from Centre for Disease Control and prevention (CDC) Plasmodium falciparum has been associated with HPS but not the Plasmodium vivax [4-7]. We report a case of hemophagocytic syndrome as a complication of Plasmodium vivax malaria which is a rare presentation according to the data. This patient presented with high grade fever with chills (P. vivax positive), fever however did not respond to anti-malarials. The patient continued to have high grade fever with altered sensorium and deranged liver function with pancytopenia. Since she fulfilled the criteria of (HPS), patient was put on injectable steroids and responded dramatically. Hemophagocytic syndrome is a potentially fatal syndrome and therefore high index suspicion and early treatment is the key to reduce the mortatlity.
Medical Laboratory Journal , 2023
Background and objectives: Malaria causes a wide spectrum of hematological and clinical manifestations. This study aimed to identify the alterations in the clinical and hematological parameters in patients infected with Plasmodium vivax, Plasmodium falciparum, and mixed species. Methods: The study included 126 smear-positive malaria cases, and various hematological parameters were studied. Results: The frequency of P. vivax, P. falciparum, and mixed species was 53.9%, 36.5%, and 9.6%, respectively. Anemia (hemoglobin <11 gm%) was seen in 79.3% of the cases, and severe anemia (hemoglobin <5g%) was detected in 27.7% of the cases. A decrease in red blood cell count was observed in 67% of P. falciparum and 47% cases of P. vivax cases. Increased red cell distribution width and erythrocyte sedimentation rate were seen in 81% and 78% of the cases, respectively. Leukocytosis and leucopenia were detected in 15% and 16% of all malaria cases, respectively. Thrombocytopenia was associated with 78% of cases infected with P. vivax. The degree of anemia was correlated with the parasite load, and the degree of parasitemia was correlated with the extent of thrombocytopenia. There were also significant variations in the mean corpuscular volume, hematocrit, mean corpuscular hemoglobin concentration, and platelet counts among malarial species (p<0.05). Conclusion: Malaria is frequently associated with anemia, thrombocytopenia, and leukopenia. Thrombocytopenia is mostly associated with P. vivax infection. On contrary, leukopenia is more prevalent in P. falciparum, followed by P. vivax and mixed parasitemia.
Clinical profiles of 13 children withPlasmodium vivaxcerebral malaria
Annals of Tropical Paediatrics, 2011
Background: Bikaner region is endemic for both P. vivax and P. falciparum malaria. Usually, cerebral malaria is caused by P. falciparum but it has been reported recently also in P. vivax mono-infection. Epidemiologic studies and clinical descriptions of P. vivax cerebral malaria in children are rare. Aims: To describe the clinical features of PCR-confirmed cerebral malaria owing to P. vivax mono-infection and its clinico-laboratory profile in Bikaner, Northwest India. Methods: This observational prospective study was based on detailed clinical and laboratory investigation of children admitted with cerebral malaria owing to P. vivax between November 2008 and December 2010. Cerebral malaria was categorised according to the WHO (2000) criteria for P. falciparum and the diagnosis of P. vivax monoinfection was established by peripheral blood film and rapid diagnostic tests and confirmed by polymerase chain reaction. The possibility of other diseases/infections causing similar illness were investigated thoroughly. Results: Thirteen children with P. vivax cerebral malaria were studied, eight of whom (61.5%) had multi-organ (two or more organs) dysfunction. Other associated severe manifestations included severe anaemia (7), hepatic dysfunction (2), renal dysfunction (2), bleeding manifestation (2), respiratory distress (2), metabolic acidosis (2) and shock (one). Hypoglycaemia was not observed in any patient. There was no evidence of neurological sequelae. All the children were managed according to WHO guidelines using intravenous artisunate. Thrombocytopenia was detected in five and hyponatraemia in four children. Conclusion: P. vivax mono-infection can cause cerebral malaria and multi-organ dysfunction.
Changing trends in the clinical and hematological profile of Plasmodium vivax mono infection
International Journal of Current Research in Medical Sciences
Background: Malaria continues to be a major public health problem in South East Asia. Plasmodium vivax is the most widely distributed human malaria parasite with an at-risk population of 2.5 billion persons. With the implementation of molecular diagnosis, it has become evident that P.vivax mono infection could also result in multiple organ dysfunction and severe life-threatening disease as seen in P. falciparum infection. Objectives: To study the changing trends in the clinical and hematological presentation of the Plasmodium vivax malaria and to sensitize the health care provider about the changing presentation of the Plasmodium vivax mono infection and to introduce a high index of suspicion against it's potentially life threatening complications hitherto considered not significantly prevalent, by printing and publishing the data thus obtained and circulating it amongst the health care providers in and around Amritsar. Methods: This is a single center prospective study including 100 children attending thalassemia day care center and on regular blood transfusion therapy for a minimum of 2 years and whose ferritin level is above 1000 μgm/dl. Detailed history and examination were recorded in the proforma. Blood was drawn for thyroid function tests and most recent ferritin value obtained from patients record was used for analysis. Results: A total of 55 cases of vivax malaria were included in the study. Severe disease was present in 19(34.5%) cases of malaria. In addition to fever, the most common clinical features at presentation in children were: fatigue in 96.4%(53/55), headache in 54% (30/55), myalgia in 54%(30/55), arthralgia in 43%(24/55), vomiting in 64% (35/55) and nausea in 58%(32/55).Hepatosplenomegaly in 51% (28/55) of patients, splenomegaly in 26% (14/55) and hepatomegaly alone in 3% (2/55), varying degrees of icterus in 20% (11/55) and respiratory distress in 12.7% (7/55). Anemia was present in 89.1% (49/55) and thrombocytopenia (platelet count < 1,50,000/μL) was present in 45.5% (25/55) of the children.
Severe and complicated Plasmodium vivax malaria in children
Tropical Doctor, 2012
Summary Plasmodium vivax, thought to be benign until recently, has been associated with severe malaria and its complications. This retrospective study describes severe and complicated P. vivax malaria in children. It affected almost all of the organ systems and the most commonly found complications were thrombocytopenia and severe anaemia. All children with malaria, including malaria caused by P. vivax, should be monitored for such complications.
Rare Case of Isolated Plasmodium Vivax Malaria Presenting with Pancytopenia: A Case Report
BJSTR
Pancytopenia is a triad of simultaneous drop in all the three major blood cells including Hemoglobin, White blood cells and Platelets. Etiology of pancytopenia is diverse comprising both hematopoietic and non-hematopoietic disorders including various infections. Malaria is a rare cause of pancytopenia which mostly occur with Plasmodium falciparum and very few cases reported with Plasmodium vivax. This is a case of a 17-year-old girl with no previous co-morbids presented with high grade fever, vomiting, loose motions and decrease appetite for 5 days. On examination she was dehydrated and pale with bruising on arms and thighs. Spleen was palpable. Rest of systemic examination was unremarkable. Complete blood picture showed decreased TLC, Low Hemoglobin and Thrombocytopenia. Liver function tests, Renal function tests, Serum electrolytes, Urine routine examination and Erythrocyte sedimentation rate were normal. C-reactive protein, LDH, Ferritin and D-dimers were raised. Peripheral film showed Retic count of 3%. Dengue serology and Covid-19 PCR was negative. Blood and Urine Cultures showed no growth. Ultrasound abdomen showed splenomegaly. Peripheral smear for Malarial Parasite showed early trophozoites of Plasmodium vivax. Patient was started on Intravenous Artesunate as she could not tolerate Oral antimalarial. Patient became afebrile and blood counts improved after few days and was discharged with follow up test for G6PD assay.
Hematology/Oncology and Stem Cell Therapy, 2016
Malaria-related hemophagocytic lymphohistiocytosis is a rare, potentially fatal, hyperinflammatory disease entity which can be challenging to diagnose and treat. It is usually associated with Plasmodium falciparum infection. It is less frequently associated with Plasmodium vivax. Here we report an unusual case of a 23-year-old healthy Nigerian man who presented with fever, microangiopathic hemolytic anemia, acute renal failure, and confusion, and was diagnosed as having cerebral malaria-related hemophagocytic lymphohistiocytosis caused by P. vivax infection. He was successfully treated with intravenous artesunate and doxycycline with dramatic clinical improvement.