Clinical Manifestations, Treatment, and Outcome of Hospitalized Patients with Plasmodium vivax Malaria in Two Indian States: A Retrospective Study

This was a retrospective study done on 110 patients hospitalized with P. vivax malaria in three medical college hospitals, one in the union territory of Chandigarh and the other two in Gujarat, that is, Ahmedabad and Surat. The clinical presentation, treatment, and outcome were recorded. As per WHO criteria for severity, 19 of 110 patients had severe disease—six patients had clinical jaundice with hepatic dysfunction, three patients had severe anemia, three had spontaneous bleeding, two had acute respiratory distress syndrome, and one had cerebral malaria, hyperparasitemia, renal failure, circulatory collapse, and metabolic acidosis. All patients with severe P. vivax malaria survived, but one child with cerebral malaria had neurological sequelae. There was wide variation in the antimalarial treatment received at the three centres. Plasmodium vivax malaria can no longer be considered a benign condition. WHO guidelines for treatment of P. vivax malaria need to be reinforced. 1. Introduction India accounts for 77% of the total malaria in south-east Asia with Plasmodium vivax being responsible for more than 50% of the cases. Although earlier regarded as causing a benign infection, there is increasing evidence that the overall burden, economic impact, and severity of P. vivax have been underestimated [1]. There are only three large studies from India which describe the whole spectrum of severe clinical manifestations of P. vivax malaria [2–4]. Also, malaria case management remains a vital component of malaria control strategies. The WHO guidelines for the treatment of malaria recommend chloroquine (except in areas of chloroquine resistance) as first-line treatment for uncomplicated P. vivax malaria with 14 days of primaquine for radical cure. The WHO guidelines for the treatment of malaria recommend that intravenous artesunate should be used for the treatment of severe malaria (falciparum and vivax) for a minimum period of 24 hours. Following initial parenteral treatment, once the patient can tolerate oral therapy, it is essential to continue and complete treatment with an effective oral antimalarial using a full course of an effective ACT (artesunate plus amodiaquine or artemether plus lumefantrine or dihydroartemisinin plus piperaquine) or artesunate (plus clindamycin or doxycycline) or quinine (plus clindamycin or doxycycline) [5]. The present study was done to evaluate the clinical manifestations and outcome in patients hospitalized with P. vivax malaria and whether WHO guidelines for treatment of P. vivax malaria were being adhered to. 2. Methods 2.1.