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Changing pattern of severe manifestations of Plasmodium falciparum and Plasmodium vivax malaria: A Retrospective study from Bikaner (Northwest) in India

 Department of Microbiology, Maharaja Ganga Singh University, Bikaner

Correspondence Address:
Dharmesh Harwani,
Academic Block 1, Department of Microbiology, Maharaja Ganga Singh University, Bikaner-334004, Rajasthan

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-9062.342396

Background & objectives: Previously there were reports from all over India about the changing spectrum of severe manifestations of Plasmodium falciparum malaria. Consequently, the present retrospective study was conducted to compare the severity of malaria caused by Plasmodium falciparum as well as Plasmodium vivax during 2007-08 and 2017-18. Methods: The present study was conducted on the patients admitted with severe malaria in a classified malaria ward of a tertiary care hospital in Bikaner, Rajasthan (Northwest India) during 2007-08 and 2017-18. It included adult patients of both sexes belonging to all age groups. The diagnosis was done by peripheral blood film (PBF), rapid diagnostic test (RDT), and validated by polymerase chain reaction (PCR). All patients were treated with intravenous oral quinine. The specific individual malaria complications registered in 2007-08 and 2017-18 were treated by following standard WHO protocol. Results: In 2007-08 the severe manifestations caused by P. falciparum was dominated by thrombocytopenia (25.98%) followed by jaundice (24.39%), multi-organ dysfunction (MODS) (16.66%), severe anemia (16.17%), cerebral malaria (5.39%), bleeding manifestation (3.92%) and shock (0.49%). While in the same year, P. vivax associated clinical spectrum of complications were observed to be dominated by thrombocytopenia (26.47%) followed by jaundice (25.00%), MODS (14.70%), severe anemia (5.88%), cerebral malaria (5.88%), renal failure (4.41%), bleeding manifestation (2.45%), shock (0.98%) and acute respiratory distress syndrome (ARDS) (0.49%). However, in 2017-18, the clinical spectrum of malaria complications caused by both species has been changed. Relative to P. falciparum infections, P. vivax individual complications like thrombocytopenia (51.78%) (p<0.001) followed by jaundice (19.13%) (p<0.001) and severe anemia (4.22%) (p<0.05) were found to be increased significantly. Interpretation & conclusion: Over the last decade there is an apparent spatial and temporal shift in the clinical manifestations of severe malaria caused by both Plasmodium species. As evident from the patient's data from 2007-08 and 2017-18, the severity is more inclined towards Plasmodium vivax than Plasmodium falciparum malaria. Moreover, individual P. falciparum-associated complications were decreased significantly in the Bikaner regionof Rajasthan .

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