Eficacia de la tafenoquina en la profilaxis y tratamiento de la malaria por Plasmodium vivax, revisión sistemática y metaanálisis / Efficacy of tafenoquine in the prophylaxis and treatment of malaria by Plasmodium vivax, systematic review and meta-analysis

Introducción. La tafenoquina fue aprobada en el 2018 por la Food and Drug Administration de Estados Unidos y, en el 2019, por la Therapeutic Goods Administration en Australia. Su administración en dosis única y su mecanismo de acción en las fases aguda y latente han sido objeto de estudio para cambiar el esquema de tratamiento de la malaria por Plasmodium vivax. Objetivo. Evaluar la evidencia científica disponible sobre la eficacia de la tafenoquina en la profilaxis y el tratamiento de la malaria por P. vivax, entre el 2009 y el 2019. Materiales y métodos. Se establecieron los descriptores MeSH y DeCS. Se utilizó la sintaxis ((Malaria Vivax) AND (tafenoquine) AND (prophylaxis)) OR [(Malaria Vivax) AND (tafenoquine) AND (relapse)] en las siguientes bases de datos: Pubmed, The Cochrane Central Register of Controlled Clinical Trials (CENTRAL), ISIS Web of Science, Lilacs y Scopus. Los resultados obtenidos se sometieron a análisis crítico (matriz CASPE). El análisis cuantitativo se realizó utilizando la diferencia de riesgos en análisis de supervivencia (Kaplan-Meier) en los tres artículos finales. Resultados. Se sometieron tres estudios a metaanálisis (Llanos-Cuentas, 2014; Llanos- Cuentas, 2019, y Lacerda, 2019) para evaluar la eficacia del tratamiento con tafenoquina en comparación con primaquina. Se obtuvo una diferencia de riesgo global de 0,04 (IC95% 0-0,08; p=0,07). La tafenoquina no mostró inferioridad en la eficacia del tratamiento frente al esquema de primaquina. Conclusión. La tafenoquina es una alternativa que mejora el cumplimiento del tratamiento, lo que podría acercar a Colombia a las metas de la Estrategia Técnica Mundial contra la Malaria, 2016-2030.

Introduction: Tafenoquine was approved in 2018 by the Food and Drug Administration in the United States and in 2019 by the Therapeutic Goods Administration in Australia. Its administration in a single dose and its mechanism of action in the acute and latent phases of the disease have been studied to change the treatment regimen for Plasmodium vivax malaria. Objective: To evaluate the available scientific evidence of the efficacy of tafenoquine in prophylaxis and treatment between 2009 and 2019. Materials and methods: We established the MeSH and DeCS descriptors and we used the syntax ((Malaria Vivax) AND (tafenoquine) AND (prophylaxis)) OR [(Malaria Vivax) AND (tafenoquine) AND (relapse)] in the following databases: Pubmed, The Cochrane Central Register of Controlled Clinical Trials (CENTRAL), ISIS Web of Science, Lilacs, and Scopus. The results obtained were subjected to critical analysis (CASPE matrix). The quantitative analysis was performed with risk differences in survival analysis (Kaplan Meier) in the final three articles. Results: Three studies underwent meta-analysis (Llanos-Cuentas, 2014; Llanos-Cuentas, 2019, and Lacerda, 2019) to evaluate the efficacy of the treatment with tafenoquine compared to primaquine. A global risk difference of 0.04 was obtained (95% CI: 0.00-0.08; p=0.07). Tafenoquine did not show inferiority in the efficacy of treatment compared to the primaquine scheme. Conclusion: Tafenoquine is a therapeutic alternative to primaquine that improves adherence, which could bring Colombia closer to the goals of the World Technical Strategy against Malaria 2016-2030.

SEVERE PLASMODIUM VIVAX MALARIA IN AN ADOLESCENT

Vivax malaria is in general described and considered as benign as it less likely causes severe illness, compared to malaria caused by Plasmodium falciparum (P.falciparum)species. Of late, there have been increasing evidences of Plasmodium Vivax (P.vivax) too causing severe disease and leading to poor outcomes.. We report a case of severe P vivax malaria in a 12 year old child complicated by Acute respiratory distress syndrome(ARDS)

Malaria Incidence of the Regions Adjacent to the Demilitarized Zone in the Democratic People's Republic of Korea, 2004–2016

BACKGROUND: Vivax malaria reemerged in the Korean peninsula in 1990s beginning from the western border area and spread across both Koreas rapidly with its peak incidences reported on the early 2000s. There have been few reports on the malaria incidence in the Democratic People's Republic of Korea (North Korea) that provides detailed epidemiological features. The purpose of this study was to describe the time trends and spatial distribution of malaria in North Korea with comparison to those in South Korean regions across the border. METHODS: The incidence of malaria in each province of North Korea from 2004 to 2016 was estimated based on data from domestic and international health authorities. Consistency of the data was evaluated by calculating the ratio of malaria cases in each province to the total cases each year. We also compared the changes in malaria incidence over time in South and North Korea adjacent to the demilitarized zone. RESULTS: In North Korea, the incidence of malaria in the three provinces adjacent to the demilitarized zone was the highest (52.1−315.3 per 100,000), followed by Pyeonganbuk-do (14.7−113.5 per 100,000), where railways and road networks were connected to northern China. The incidence of malaria in each province of North Korea reported after 2011 was more consistent than when compared with previous annual data, and there was also a positive correlation between changes in incidence over time when compared with malaria incidence in South Korea (r = 0.855, r = 0.596). CONCLUSION: The malaria report of North Korea was relatively consistent in its spatiotemporal tendency since 2011, suggesting improvement of the quality of the surveillance data. The strong correlation between North and South Korean malaria incidence at regional level suggests that collaboration between both sides are essential for the successful elimination of malaria in the Korean peninsula.

A Clinical Study on Thrombocytopaenia in Viral Fevers and Malaria

Background:Thrombocytopaenia, decrease platelate count is seen in many viral fevers including heptitis 'C', HIV infections and malaria which is very comman in developing countries.[1] In Thrombocytopaenia due to viral Haemorrhagic fever, others features like increased haematocrit, leucopenia will present along with Thrombocytopaenia. Automated quatitative D3 analysis is used to detect Thrombocytopaeniain our study the commonest causes of Thrombocytopaenia is vivax malaria. Aims and Objectives: This study is to evaluate the Thrombocytopaenia as diagnostic and prognostic tool in viral fevers and malaria. Methods: In our study we have examined 200 patient’s acute febrile illness out of these 200 patients, 10 were diagnosed as dengue fever, 100 were diagnosed as Malaria. Thick and thin blood fever slides were prepared and examined by pathologist. Results: Out of 200 patients 110 were diagnosed as Malaria, 10 patients were diagnosed as Dengue fever Thrombocytopaenia is observed in 60 patients. Conclusion: Thrombocytopaenia is common in viral fevers and Malaria. After exclusion of dengue fever, malaria should be considered in all the patients with low platelet counts.

A Study on Predictive Value of Thrombocytopaenia in Cases of Malaria

Malaria is a major health problem in India. In cases of fever with thrombocytopenia, malaria should be on top of the differential diagnosis. This was a study of admitted patients in medical wards of Bhaskara Medical Colleges, Hyderabad who were diagnosed with malaria and they were assessed for thrombocytopenia using automated quantitative D3 analyser. The data were analysed using SPSS version 16.0. Viral haemorrhagic fevers can also be presented as fever with high haematocrit and leucopenia along with thrombocytopenia. In our study, the commonest cause of thrombocytopenia in malaria was vivax malaria.

Malaria congénita en un hospital de Iquitos, Perú / Congenital malaria in a hospital in Iquitos, Peru

Objetivos. Determinar la frecuencia y características clínicas de los recién nacidos con malaria congénita en el Hospital de Apoyo de Iquitos en la Amazonía peruana. Materiales y métodos. Estudio descriptivo, prospectivo y transversal. De enero de 2011 a diciembre de 2013 se estudiaron 14 017 recién nacidos y a sus madres, de quienes se seleccionaron 52 portadoras de malaria gestacional mientras que a sus recién nacidos se les hospitalizó en el Servicio de Neonatología del hospital, y fueron sometidos a evaluación clínica y estudios de laboratorio. Resultados. La frecuencia de malaria gestacional fue de 0,4% y una proporción de malaria congénita de 9,6%. Plasmodium vivax fue hallado en 80% de casos de malaria gestacional y en 60% de malaria congénita. Se observó un caso de óbito fetal con gota gruesa positiva para Plasmodium falciparum. El cuadro clínico en recién nacidos fue fiebre, hipoactividad, irritabilidad y pobre succión. Conclusiones. Se documenta la presencia de malaria congénita en recién nacidos de madres con malaria gestacional. El cuadro clínico se asemeja a una sepsis neonatal. El diagnóstico precoz de malaria congénita y el tratamiento oportuno cursan con buena evolución.

Objectives. To determine the frequency and clinical features of newborns with congenital malaria in the Hospital de Apoyo of Iquitos in the Peruvian Amazon. Materials and methods. Descriptive, prospective and cross-sectional study. From January 2011 to December 2013, 14.017 newborns and their mothers were studied, of whom 52 carriers of gestational malaria were selected while their infants were hospitalized in the Neonatology Unit, and underwent clinical assessment and laboratory studies. Results. Gestational malaria frequency was 0.4% and a proportion of 9.6% of congenital malaria. Plasmodium vivax was found in 80% of cases of gestational malaria and in 60% of congenital malaria. A case of fetal death with positive thick blood smear for Plasmodium falciparum was observed. The clinical presentation in newborns was fever, hypoactivity, irritability and poor suction. Conclusions. The presence of congenital malaria in infants born to mothers with gestational malaria is documented. The clinical picture resembled neonatal sepsis. Early diagnosis of congenital malaria and timely treatment present with good evolution.

The prognostic utility of bedside assessment of adults hospitalized.

Background: Data collected in clinical trials have been used to develop scoring systems that identify adults with malaria at greatest risk of death. One of these, the RCAM score, can be simply determined by measuring a patient’s Glasgow Coma Score and respiratory rate on admission to hospital. However the safety of using the RCAM score to define high-risk patients has not been assessed outside of the clinical trial setting. Methods: A retrospective audit of medical records of all adults admitted with a diagnosis of malaria to two tertiary referral hospitals in Lower Myanmar in 2013 was undertaken. An RCAM score was calculated in all patients and related to their subsequent clinical course. Results: The recent decline in malaria hospitalizations at both sites continued in 2013. During the year 90 adults were hospitalized with malaria; 62 (69%) had Plasmodium falciparum monoinfection, 11 (12%) had Plasmodium vivax mono-infection, 17 (19%) had mixed infection. All seven (7.7%) deaths occurred in patients infected with P. falciparum. An admission RCAM score < 2 identified all the patients that would survive to discharge (positive predictive value (95% confidence interval (CI)) 100% (94.9-100%) and also predicted a requirement for less supportive care: 9/70 (13%) patients with an admission RCAM score < 2 required supportive care (blood transfusion, vasopressor support or oxygen supplementation) during their hospitalization compared with 12/20 (60%) patients with an admission RCAM score ≥ 2 (p < 0.0001). No patient with P. vivax monoinfectionrequired supportive care during their hospitalization. Patients with an oxygen saturation ≤ 95% on room air on admission were more likely to die before discharge (odds ratio 17.3 (95% CI: 2.9-101.2) than patients with a higher oxygen saturation (p = 0.002). Conclusions: Even outside a clinical trial setting the RCAM score reliably identifies adults with malaria who are at greatest risk of death and can be safely used in the initial triage and management of these patients.

Myocarditis associated with Plasmodium vivax malaria: a case report

Malaria remains a major public health problem in Brazil where Plasmodium vivax is the predominant species, responsible for 82% of registered cases in 2013. Though benign, P. vivax infection may sometimes evolve with complications and a fatal outcome. Here, we report a severe case of P. vivax malaria in a 35-year-old Brazilian man from a malaria endemic area, who presented with reversible myocarditis.

Clinical Profile of Vivax Malaria among Children in a Tertiary Care Hospital.

Malaria is endemic in India. Vivax malaria has been traditionally described as benign tertian malaria but recent reports from many centers have revealed that it can cause life threatening disease as seen in case of falciparum malaria.There is paucity of data on this topic from this region. Objective: The present study is aimed to find out the clinical features, complications, response to treatment and outcome of patients suffering from vivax malaria in children. The study has also tried to focus on the severe illnesses associated with P. vivax infection. Material and Methods: The study was performed at a tertiary care hospital of Uttrakhand. The study period was of two years, from August 2011 to July 2013. Patients of 18 years of age or below it who were smear positive or antigen positive were included in the study. All such patients who were admitted in the hospital underwent detailed investigation. The data analysed to find out their clinical profile, laboratory manifestations and outcome. Result: 72 patients were identified as suffering from plasmodium vivax malaria. Splenomegaly, hepatomegaly, hepatosplenomegaly, were common findings. Renal, hepatic and cerebral dysfunctions were noted, severe malaria was observed in 28(38.9%). Thrombocytopenia was the commonest hematological abnormality. 5(6.9%) patients died. Cerebral malaria, shock and ARDS were associated with high mortality. Conclusion: Vivax malaria, in its severe form, may cause life threatening complications. The clinical profile in such patients is similar to those which have been traditionally described with falciparum malaria.

A comparative study of complications of vivax and falciparum malaria in Dehradun, India.

Background: Traditionally Plasmodium falciparum has been considered to cause severe malaria while Plasmodium vivax is known to cause benign malaria. However many recent studies have shown that Plasmodium vivax is also responsible for many cases of severe malaria. There is scarcity of data on this topic from this region. The present study was conducted to find out clinical and pathological manifestations of vivax and falciparum malaria in Dehradun. Methods: The study period was of one and half years, from January 2012 to June 2013. Patients of 18 years of age or above it who were smear positive or antigen positive were included in the study. Results: one hundred and thirty nine patients were found to be suffering from malaria. 90 (64.7%) had vivax malaria, while 49 (35.3%) patients suffered from falciparum. The study of morbidity profile showed that the complications related to severity, earlier attributed to only falciparum is equally seen in vivax case. Low platelet count was the commonest finding in both groups. Other complications seen in both groups were those of severe anemia, cerebral malaria, ARDS, renal failure, hepatitis, leucocytopenia, pancytopenia, and shock. Mortality in the two groups was of the same order. Conclusions: Vivax malaria causes significant mortality and morbidity. The morbidity and patterns are almost similar in both vivax and falciparum malaria.

Incidence of Jaundice in Plasmodium Vivax Malaria: A Prospective Study in Moodabidri, South India

Background: A prospective study was taken to look for the incidence of jaundice in Plasmodium vivax malaria patients in Moodabidri, a coastal town of South India. Methods: A prospective study was conducted in the patients admitted with the diagnosis of Plasmodium vivax malaria at the Alva’s health centre, during study period 1st Jun 2011 to 10th October 2012. Bilirubin levels were checked in all the selected patients. Patients who had their total bilirubin level 3.0 mg% or more were considered to be having jaundice and were further tested for anemia and hepatic dysfunction by carrying out hemoglobin (Hb), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), surface antigen of the hepatitis B virus (HBsAg). The data collected were analysed statistically. Results: A total of 188 patients who had Plasmodium vivax malaria as diagnosed by peripheral blood film (PBF) and rapid diagnostic test (RDT) were included in the study. Jaundice was present in 19 (10.1%) patients and the mean (SD) level of serum bilirubin was 4.5 mg/dL (2.4) (maximum = 12.7 mg %) with 94.7% (n = 18) of the patients having predominantly indirect type or unconjugated hyperbilirubinemia. The hepatic dysfunction was present in 15 (78.9%) with mean (SD) level of aspartate aminotransferase (AST) was 61.57 IU/L (SD 33.8) (maximum = 160 IU/L) and alanine aminotransferase (ALT) was 54.8 IU/L (SD 21.2) (maximum = 108 IU/L). Anemia was present in 3 (15.8%) patients and the mean hemoglobin level was 12.8 gm/dL (SD 1.8) (minimum = 6.4 gm/dL). Out of 19 patients who had jaundice majority were males (94.7 %, n = 18) and only one female (5.3%, n = 1) was found to be having jaundice. The age of the patients who had jaundice ranged from 17 to 60 years 29 years (SD 13.7). Conclusion: This study has further reiterated the fact that Plasmodium vivax malaria is no longer a “benign” disease and it can also produce jaundice, hepatic dysfunction, and anemia.

Spontaneous splenic rupture in Plasmodium vivax malaria

Malaria can present with various clinical symptoms and complications. While a tertian malaria form that is especially prevalent in Korea is characterized by mild clinical progression, occasional splenic complications are known to occur. A 26-year-old Korean male soldier without prior medical history visited The Armed Forces Capital Hospital with left upper quadrant abdominal pain one day ago. Hemostasis under laparoscopic approach was attempted. The operation was converted into laparotomy due to friable splenic tissue and consequently poor hemostasis. Splenectomy was performed. The patient was discharged at postoperative day 17 without complication. While numerous diseases can result in splenic complications, such as splenic rupture, malarial infection is known as the most common cause. The incidence of malarial infection in Korea is increasing annually, and there are occasional reports of splenic rupture due to the infection, which requires attention.

Situation of P. vivax malaria in Ahmedabad city – A study in purview of national guidelines.

Background: Malaria is still the most important cause of morbidity-mortality in India. NVBDCP in urban areas is implemented through UHCs. In Gujarat, 89764 malaria cases were reported in 2011 with 127 deaths with 17.9% of them being the P. vivax (Pv) cases. Ahmedabad is at the receiving end of malaria menace due to its rapid growth. Compared to 2011, significant rise in number of Pv cases has been observed in Ahmedabad in 2012. Aims & Objective: The study was carried out to assess the Pv malaria detection modalities, relevant indices, existing radical treatment strategies and adherence to national guidelines in the urban areas of Ahmedabad. Material and Methods: Data of all 9 UHCs of south zone, catering total population of approximately 1 million and showing significant rise in Pv cases were verified clubbed with field analysis, for the corresponding quarters of March, April and May of two consecutive years–2011-2012. Concerned healthcare staff was interviewed. Guidelines and definitions of national anti-malarial guidelines and operational manual were followed. Process indicators for surveillance, case finding and disease burden were considered. Results: Out of total blood smears examined, Pv cases raised from 97 (2011) to 382 (2012). Statistically significant rise of Pv% was 0.35% and 2.79% in active and passive slide collection respectively. 71% slides were actively collected in both years. QBER rose from 1.50% to 2.41%. QPI rose from 0.12 to 0.39. Successful RT completion decreased from 59.8% to 29.1%. Knowledge regarding national-anti-malarial-guidelines was satisfactory in more than 70% of healthcare functionaries. Conclusion: Number of cases significantly increased in two years, Pv-positivity rise being 1.04%. Active slide collection is static. Rise in Pv-positivity should trigger improvement in the same. Average QBER and QPI rose in two years. QBER never reached prescribed levels. Successful RT-completion is the key towards drug-resistance and relapse prevention. Adherence to national-anti-malarial-guideline is imperative.

Complications of vivax malaria in Uttarakhand, India.

Background: Malaria is an important cause of mortality and morbidity in India. Many recent studies have shown that vivax malaria which was once thought to be a benign condition has emerged in a more virulent form causing many cases of severe malaria and life threatening complications. There is paucity of data on this topic from this region. Objective: The present study was conducted to find out the clinical features, complications, response to treatment and outcome of patients suffering from vivax malaria. The study has also tried to find out severe malaria associated with P. vivax infection. Methods: The study was performed at SGRR Institute of Medical & Health Sciences, Dehradun, which is a tertiary care hospital of Uttarakhand. The study period was of two years, from September 2011 to August 2013. Patients of 18 years of age or above it who were smear positive or antigen positive were included in the study. All such patients who were admitted in the hospital underwent detailed clinical examination and investigation. Results: Plasmodium vivax infection was identified in 140 patients. Splenomegaly, hepatomegaly, and hepatosplenomegaly, were common findings. Renal, hepatic and cerebral dysfunctions were noted. Severe malaria was observed in 63(45.0%). Thrombocytopenia was the commonest hematological abnormality. Mortality was seen in 9(6.4%) patients. Cerebral malaria, shock and ARDS were associated with high mortality and poor outcome. Conclusion: Vivax malaria may cause life threatening complications. The complications of vivax malaria are similar to those which have been traditionally described with falciparum malaria.

Platelet count – a diagnostic aid in fever.

Introduction: Vivax Malarial infection. Dengue Viral fever is also emerging as a Febrile conditions to have reduced platelet count. The absence of the normal platelet count on peripheral smear in case of fever is a clue to the presence of Malaria and Dengue fever. Material & Method: Present study we have tried to study the pattern of thrombocytopenia in these febrile conditions and their diagnostic and prognostic implications. The study was conducted at GMERs Medical College, Gandhinagar. This study group consisted of 146 Patients of Fever treated at Pediatric Department, Malaria diagnosed by thick & thin smear examination. The platelet count was done by Abascus Junior B- Blood Cell counter. Dengue Fever was diagnosed by NS1 Antigen Test. The Mean Platelet counts in P. Falciparum are 69852 cells/mm3, P.Vivax 1,15,580 and Dengue Fever 53,100. Statistically the difference between P. Falciparum & Vivax is significant for differentiating Malarial type. Result: Platelet count <20,0000 cells/mm3 was observed in both the types of Malaria and not seen with Dengue Fever. Profound thrombocytopenia still remains the distinguishing, feature of P. Falciparum Malaria. Platelet count more than 1,00,000 cells/mm3 favours the diagnosis of P.Vivax & Moderate reduction in Platelet Count (between 20,000 to 1,00,00) is clue to P. Falciparum and Dengue Fever. In this segment other diagnostic criteria like pFHrp Antigen and N.S.Antigen should be applied to differentiate these two grave conditions. Thrombocytopenia (Platelet count <150000 cells/mm3) can be considered as a predictor of Malaria and in combination with Anemia (Hb<10gm/dl) is a next best parameter. Unlike Malaria, in Dengue fever thrombocytopenia is usually associated with normal Hemoglobin.

A Case of Vivax Malaria Complicated by Adult Respiratory Distress Syndrome and Successful Management with Extracorporeal Membrane Oxygenation

Complicated malaria is mainly caused by Plasmodium falciparum, but, increasingly, Plasmodium vivax is also being reported as a cause. Since the reemergence of indigenous vivax malaria in 1993, cases of severe malaria have been steadily reported in Korea. Herein, we report a case of vivax malaria complicated by adult respiratory distress syndrome (ARDS) that was successfully managed with extracorporeal membrane oxygenation (ECMO). A 59-year-old man presented at our hospital with fever and abdominal pain, which had persisted for 10 days. On admission, the patient had impaired consciousness, shock, hypoxia and haziness in both lungs, jaundice, thrombocytopenia and disseminated intravascular coagulation, metabolic acidosis, and acute kidney injury. A peripheral blood smear and a rapid diagnostic test verified P. vivax mono-infection. Ten hours after admission, hypoxia became more severe, despite providing maximal ventilatory support. The administration of antimalarial agents, ECMO, and continuous venovenous hemofiltration resulted in an improvement of his vital signs and laboratory findings. He was discharged from the hospital 7 weeks later, without any sequelae.

Clinical Characteristics of Vivax Malaria and Analysis of Recurred Patients / 감염과화학요법

BACKGROUND: Plasmodium vivax malaria is an acute debilitating illness characterized by recurrent paroxysmal fever and relapses from hypnozoites in the liver. Although a few studies reported clinical characteristics of vivax malaria in civilians after reemergence in the Republic of Korea, only a small group of patients was analyzed. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had been diagnosed with vivax malaria by peripheral blood smear in a university-affiliated hospital located in a malaria-endemic area between January 2005 and December 2009. RESULTS: During the study period, a total of 352 malarial cases from 341 patients were diagnosed. Vivax malaria was most commonly developed in July and August, 24.7% (87/352), and 21.9% (77/352), respectively. The mean (SD) age was 42.5 (14.7) years and the number of male patients was 243 (71.3%). Six patients had a previous history of vivax malaria from 6 months to 10 years before. A total of 337 patients (98.8%) had fever and the mean (SD) body temperature was 38.3 (1.4)degrees C. Common associated symptoms were chills (213/341, 62.5%), headache (115/341, 33.7%), and myalgia (85/341, 24.9%). Laboratory findings included thrombocytopenia (340/341, 99.7%), anemia (97/341, 28.5%), leukopenia (148/341, 43.4%), increase of aspartate transaminase (177/341, 51.9%), and increase of alanine transaminase (187/341, 54.8%). Hypotension (14/341, 4.1%), altered mentality (3/341, 0.9%), azotemia (3/341, 0.9%), spleen infarction (2/341, 0.6%), and spleen rupture (1/341, 0.3%) developed as complications. Chloroquine was administered to all patients and primaquine was administered with mean (SD) 3.39 (0.82) mg/kg to 320 patients. There were 11 recurrent infections during the study period. The median (range) time to recurrent infection was 100 (32-285) days. Platelet counts were higher (86,550 vs. 56,910/mm3) and time to treatment of malaria was shorter (5 vs. 7 days) in relapsed cases compared with first occurrence cases (P=0.046). CONCLUSIONS: The overall recurrence rate of vivax malaria was 3.2% (11/341) in this study. In recurred cases, malaria was diagnosed earlier and thrombocytopenia was less severe. To evaluate the risk factors associated with recurrence and adequate dose of primaquine in Korean patients, further large-scale prospective studies will be needed.

Thrombocytopenia in p. vivax malaria.

Backgroud: Plasmodium Falciparum and P. Vivax are endemic infections in India and commonly associated with Hematological Abnormalities. Severe thrombocytopenia is frequently noticed with P. Falciparum Malaria, but its occurrence is less reported and studied with P. Vivax Malaria. In present study we have tried to evaluate severity & prognostic implications of thrombocytopenia in cases of P Vivax Malaria. The study was conducted in Department of Pediatrics, GMERS Medical College, Gandhinagar.Method: The study group consisted of 92 Pediatric Patients diagnosed on thick & thin blood smear examination having thrombocytopenia. The platelet counts were done by Abacus Junior B Blood Cell Counter. Result: Platelet Count <150000 Cell/mm3 (thrombocytopenia) was observed in 73.92% patients of P. Vivax Malaria. The mean platelet count 1,16,520 is significantly low and the range being 18000 cell/mm3 to 5,10,000 cells/mm3. Anaemia with mean Hemolobin level 8.8 gm/dl. was reported in the patients with P. Vivax Malaria with thrombocytopenia. Discusssion: In our view, this statistically low platelet count in P.Vivax Malaria is having significance & should be kept as differential diagnosis in Acute Febrile conditions. Unnecessary Platelet transfusions can be prevented as noticed in the study. Platelet transfusion was not required in the patients having severe thrombocytopenia (platelet count <20000 cells/mm3)as bleeding tendencies and systemic complications were not observed as compared to Falciparum Malaria. Platelet count and clinical recovery were immediate on 2nd day after initiation of treatment and complete recovery within 7 day without any complications and mortality suggest a good prognosis. Conclusion: Anaemia with severe thrombocytopenia in P. Vivax Malaria required further study to differentiate other febrile conditions with low platelet count and unaltered hemoglobin levels.

Habitat suitability of Anopheles vector species and association with human malaria in the Atlantic Forest in south-eastern Brazil

Every year, autochthonous cases of Plasmodium vivax malaria occur in low-endemicity areas of Vale do Ribeira in the south-eastern part of the Atlantic Forest, state of São Paulo, where Anopheles cruzii and Anopheles bellator are considered the primary vectors. However, other species in the subgenus Nyssorhynchus of Anopheles (e.g., Anopheles marajoara) are abundant and may participate in the dynamics of malarial transmission in that region. The objectives of the present study were to assess the spatial distribution of An. cruzii, An. bellator and An. marajoara and to associate the presence of these species with malaria cases in the municipalities of the Vale do Ribeira. Potential habitat suitability modelling was applied to determine both the spatial distribution of An. cruzii, An. bellator and An. marajoara and to establish the density of each species. Poisson regression was utilized to associate malaria cases with estimated vector densities. As a result, An. cruzii was correlated with the forested slopes of the Serra do Mar, An. bellator with the coastal plain and An. marajoara with the deforested areas. Moreover, both An. marajoara and An. cruzii were positively associated with malaria cases. Considering that An. marajoara was demonstrated to be a primary vector of human Plasmodium in the rural areas of the state of Amapá, more attention should be given to the species in the deforested areas of the Atlantic Forest, where it might be a secondary vector.