Malaria en pacientes con infección por VIH: serie de casos en un hospital peruano / Malaria in HIV-Infected patients: a series of cases in a peruvian hospital

RESUMEN Las manifestaciones clínicas de la malaria en pacientes con VIH pueden ser variables dependiendo del estado inmunológico del paciente. La evidencia en relación a la coinfección es escasa a nivel nacional. Se describen cuatro casos procedentes de un hospital de Iquitos-Perú con diagnóstico de infección por VIH y examen de sangre positivo para malaria. De estos pacientes, dos tenían infección por Plasmodium falciparum y dos por Plasmodium vivax. Un paciente se encontraba en estadio sida con mala adherencia a la terapia antirretroviral combinada (TARVc) y el resto se encontraba en estadios tempranos sin recibir TARVc.

ABSTRACT The clinical signs of malaria in HIV patients may vary depending on the immunological status of the patient. Nationally, evidence regarding co-infection is scarce. This research describes four cases from a hospital in Iquitos, Peru, of patients diagnosed with HIV infection and a positive blood test for malaria. Two of these patients had Plasmodium falciparum infection, and two had Plasmodium vivax infection. One of the patients was in the AIDS stage with poor adherence to combination antiretroviral therapy (cART), and the other three were in the early stages and not receiving cART.

Malaria grave en mujeres gestantes hospitalizadas entre el 2010 y el 2014 en el departamento de Antioquia, Colombia / Severe malaria in pregnant women hospitalized between 2010 and 2014 in the Department of Antioquia (Colombia)

Resumen Introducción. La malaria (o paludismo) durante la gestación impacta negativamente la salud de la madre y del neonato, con alto riesgo de complicaciones clínicas y mortalidad. En las regiones de alta endemia se han caracterizado, especialmente, la anemia materna y el bajo peso al nacer, pero es poco conocido el espectro clínico en las zonas de baja endemia. Objetivo. Caracterizar clínica y epidemiológicamente los episodios de malaria en mujeres gestantes hospitalizadas en el departamento de Antioquia entre el 2010 y el 2014. Materiales y métodos. Se hizo un estudio descriptivo, transversal y retrospectivo, con historias clínicas de mujeres gestantes con malaria por Plasmodium falciparum y P. vivax. Se utilizaron los criterios diagnósticos de malaria complicada de la Organización Mundial de la Salud (OMS) y de la Guía para la atención clínica integral del paciente con malaria vigente en Colombia. Resultados. Se analizaron 111 casos; el 13,5 % se clasificó como complicación grave según los criterios de la OMS, porcentaje que ascendió a 23,4 % según los criterios de la guía colombiana. Las complicaciones detectadas fueron disfunción hepática, anemia, acidosis y trombocitopenia grave. No se observó diferencia en la frecuencia de las complicaciones según la especie de plasmodio. El 39,4 % de los casos presentó signos generales de peligro; la palidez y la ictericia fueron los más frecuentes. El 40,5 % presentó signos de peligro para la gestación como la cefalea persistente, el dolor abdominal y el sangrado vaginal. Conclusiones. La malaria grave se presenta con gran frecuencia en las mujeres gestantes, sin diferencia según la especie de plasmodio, y se manifiesta con signos de peligro precozmente reconocibles. Se encontró un subregistro hospitalario del 88 % de los casos graves y falta de exámenes de laboratorio para un diagnóstico más completo. Se requiere un protocolo para el diagnóstico clínico de las mujeres gestantes con malaria.

Abstract Introduction: Malaria during pregnancy has a negative impact on maternal-neonatal health, with a high risk of clinic complications and mortality. High endemic areas are specially characterized by maternal anaemia and low birth weight. The clinical spectrum is little known in low endemic areas. Objective: To clinically and epidemiologically characterize malaria episodes in hospitalized pregnant women in the Department of Antioquia (Colombia) in the period 2010-2014. Materials and methods: Retrospective, cross-sectional, descriptive study with medical records of pregnant women with P. falciparum and P. vivax malaria. The WHO severe malaria diagnostic criteria and the Colombian Guía para la atención clínica integral del paciente con malaria (guidelines for comprehensive malaria treatment) were used. Results: We analyzed 111 cases, out of which 13.5% were classified as severe malaria according to the WHO criteria. Following the Colombian Guidelines, the proportion increased to 23.4%. Identified complications included hepatic dysfunction, anaemia, acidosis, and severe thrombocytopenia. No difference in the frequency of complications by Plasmodium species was observed; 39.4% of the cases presented general danger signs, pallor and jaundice being the most frequent; 40.5% showed danger signs for pregnancy, such as persistent headache, abdominal pain, and vaginal bleeding. Conclusions: Severe malaria is a highly frequent event in pregnant women, without differences by Plasmodium species. It shows early recognizable dangers signs. Hospital under-reporting was identified in 88% of severe cases as well as a lack of laboratory tests for a more comprehensive diagnosis. A protocol for the clinical diagnosis of pregnant women with malaria is required.

Descripción de casos de coinfección dengue y malaria, Hospital Escuela Universitario, Tegucigalpa, Honduras, 2010-2014 / Description of cases of dengue and malaria coinfection, Hospital Escuela Universitario, Tegucigalpa, Honduras, 2010 ­ 2014

Antecedentes: Honduras es país endémico de dengue y malaria. La coinfección se informa poco, con posible sub-registro. Se ha descrito una presentación clínica más severa que en las infecciones individuales. Objetivo: Identificar frecuencia y ca-racterizar los casos de coinfección dengue y malaria,Hospital Escuela Universitario (HEU), 2010-2014. Métodos: Estudio descriptivo transversal.Identificación de casos mediantecomparación del registro de malaria, Servicio de Parasitología HEU, con base de datos dengue, Departamento Vigilancia de la Salud HEU y Laboratorio Nacional Virología, Secretaría de Salud. Se revisaron expedientes clínicos. Caso: sujeto con diagnósticos de dengue y malaria, confirmados por laboratorio; caso sospechoso: sujeto con malaria con-firmada y certificado como dengue por Comisión de Certificación sin confirmación por laboratorio. Resultados: Se registraron 6,164 casos de dengue, 216 de malaria y 27 sospechosos de coinfección. Tres casos confirmados como coinfección (7.5% de casos malaria y 2.5% de dengue, año 2012): mujeres): mujeres, edad promedio 21 años (rango 14-34), procedencia Francisco Morazán, Olancho y Comayagua; todos Plasmodium vivax, un caso malaria complicada; todos dengue no grave y manejados como grupo B. No fueron confirmados 24 casos sospechosos, 47.8% (11/27) no estaba en base de datos de Laboratorio de Virología, 17.3% (4/23) sin resultado de laboratorio, 21.7% (5/27) tenía resultado IgM Negativo (4 con muestra inadecuada). Discusión: Se confirmó coinfección dengue y malaria en tres pacientes en 2012. Se documentó fallas en registro de la información dificultando un análisis adecuado. La vigilancia de la coinfección puede ser más eficiente a partir de casos confirmados de malaria...(AU)

Spontaneous Splenic Rupture in a Vivax Malaria Case Treated with Transcatheter Coil Embolization of the Splenic Artery

An enlarged spleen is considered one of the most common signs of malaria, and splenic rupture rarely occurs as an important life-threatening complication. Splenectomy has been recommended as the treatment of choice for hemodynamically unstable patients. However, a very limited number of splenic rupture patients have been treated with transcatheter coil embolization. Here we report a 38-year-old Korean vivax malaria patient with ruptured spleen who was treated successfully by embolization of the splenic artery. The present study showed that angiographic embolization of the splenic artery may be an appropriate option to avoid perioperative harmful effects of splenectomy in malaria 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.

An unusual case of heart failure due to Plasmodium vivax infection with a favorable outcome

Although malaria is one of the oldest types of parasitic infection, we have recently witnessed substantial changes in the outcome of malarial infections. Severe Plasmodium vivax infections have recently become more frequent, and are occasionally associated with fatal outcomes. Cardiac arrhythmia and myocardial failure have also been reported, typically in association with Plasmodium falciparum infections. We report a case of myocarditis and heart failure, due to Plasmodium vivax infection, along with the favorable outcome.

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.

Influence of age on the haemoglobin concentration of malaria-infected patients in a reference centre in the Brazilian Amazon

Anaemia is amongst the major complications of malaria, a major public health problem in the Amazon Region in Latin America. We examined the haemoglobin (Hb) concentrations of malaria-infected patients and compared it to that of malaria-negative febrile patients and afebrile controls. The haematological parameters of febrile patients who had a thick-blood-smear performed at an infectious diseases reference centre of the Brazilian Amazon between December 2009-January 2012 were retrieved together with clinical data. An afebrile community control group was composed from a survey performed in a malaria-endemic area. Hb concentrations and anaemia prevalence were analysed according to clinical-epidemiological status and demographic characteristics. In total, 7,831 observations were included. Patients with Plasmodium falciparum infection had lower mean Hb concentrations (10.5 g/dL) followed by P. vivax-infected individuals (12.4 g/dL), community controls (12.8 g/dL) and malaria-negative febrile patients (13.1 g/dL) (p < 0.001). Age, gender and clinical-epidemiological status were strong independent predictors for both outcomes. Amongst malaria-infected individuals, women in the reproductive age had considerably lower Hb concentrations. In this moderate transmission intensity setting, both vivax and falciparum malaria are associated with reduced Hb concentrations and risk of anaemia throughout a wide age range.

Platelet profile is associated with clinical complications in patients with vivax and falciparum malaria in Colombia

Introduction Thrombocytopenia is a common complication in malaria patients. The relationship between abnormal platelet profile and clinical status in malaria patients is unclear. In low and unstable endemic regions where vivax malaria predominates, the hematologic profiles of malaria patients and their clinical utility are poorly understood. The aim of this study was to characterize the thrombograms of malaria patients from Colombia, where Plasmodium vivax infection is common, and to explore the relationship between thrombograms and clinical status. Methods Eight hundred sixty-two malaria patients were enrolled, including 533 (61.8%) patients infected with Plasmodium falciparum, 311 (36.1%) patients infected with Plasmodium vivax and 18 (2.1%) patients with mixed infections. Results The most frequently observed changes were low platelet count (PC) and high platelet distribution width (PDW), which were observed in 65% of patients; thrombocytopenia with <50,000 platelets/µL was identified in 11% of patients. Patients with complications had lower PC and plateletcrit (PT) and higher PDW values. A higher risk of thrombocytopenia was identified in patients with severe anemia, neurologic complications, pulmonary complications, liver dysfunction, renal impairment and severe hypoglycemia. The presence of thrombocytopenia (<150,000 platelets/µL) was associated with a higher probability of liver dysfunction. Conclusions Young age, longer duration of illness and higher parasitemia are associated with severe thrombocytopenia. Our study showed that thrombocytopenia is related to malaria complications, especially liver dysfunction. High PDW in patients with severe malaria may explain the mechanisms of thrombocytopenia that is common in this group of patients. .

Caracterização molecular de Plasmodium vivax isolados de infecções primárias e recaídas e a influência da homeostase do ferro na ativação dos hipnozoítos

As hipóteses deste trabalho são a de que parasitos que causam recaídas são geneticamente homólogos aos parasitos das infecções primárias e que infecções múltiplas podem estar presentes nas infecções primárias e recaídas; Além dessas, outra hipótese é de que a hepcidina esteja envolvida no desenvolvimento de recaídas. Neste contexto, o objetivo do trabalho foi analisar a variabilidade genética de isolados de amostras pareadas infecção primária/recaídas de um mesmo paciente e investigar a associação entre a homeostase do ferro, particularmente da hepcidina e sua associação com a ativação dos hipnozoítos além de avaliar a resposta imunológica contra os principais antígenos do P. vivax. Sessenta e cinco amostras pareadas de 30 pacientes foram genotipadas utilizando 10 marcadores moleculares através de eletroforese capilar. Além disso, a presença de infecção múltipla nos pacientes foi confirmada através da clonagem dos fragmentos amplificados dos microssatélites e genotipagem a partir de diferentes colônias. Na análise baseada nos alelos predominantes foi demonstrado que os parasitos da recaída são principalmente heterólogos em relação à infecção primária e que geralmente ocorre uma flutuação entre os alelos predominantes nos diferentes episódios do indivíduo. Entretanto, o número de alelos por marcador foi limitado e geralmente os alelos foram idênticos nos diferentes episódios da doença num mesmo paciente.

A principal contribuição deste estudo foi demonstrar uma alta taxa de infecções múltiplas tanto das infecções primárias como nas recaídas, sendo que infecções múltiplas puderam ser identificadas com um mínimo de Cinco marcadores.Foram feitas dosagens bioquímicas de ferro, ferritina, níveis de hepcidina e análise de outras variáveis como hemoglobina e parasitemia dos pacientes. Houve diferença significativa entre os grupos somente na análise de níveis de hemoglobina sendo maior nas recaídas. Acredita-se que o número de amostras foi um limitante das análises estatísticas. O gene codificador da hepcidina foi sequenciado nas amostras de área sem transmissão e de área endêmica. Não foram encontrado polimorfismos nesse gene mostrando seu alto grau de conservação. Não foi observada diferença nos níveis de resposta imunológica contra os antígenos do P. vivax nas infecções primárias e recaídas. As infecções por este parasito são observadas com alta diversidade genética e com a presença de múltiplas variantes em uma mesma infecção, sendo esta, primária ou recaída da doença, variantes que podem sofrer variações em sua frequência durante a evolução da doença. Com estes resultados espera-se contribuir para o esclarecimento dos aspectos relacionados à diversidade genética dos parasitos e dos mecanismos que influenciam o desenvolvimento das recaídas do P. vivax, que poderão ajudar no seu prognóstico, direcionamento o tratamento e auxiliando no controle da doença.

Caracterização molecular de Plasmodium vivax isolados de infecções primárias e recaídas e a influência da homeostase do ferro na ativação dos hipnozoítos / Molecular characterization of isolates of Plasmodium vivax primary infection and relapse and influence of iron homeostasis in the activation of hypnozoites

As hipóteses deste trabalho são a de que parasitos que causam recaídas são geneticamente homólogos aos parasitos das infecções primárias e que infecções múltiplas podem estar presentes nas infecções primárias e recaídas; Além dessas, outra hipótese é de que a hepcidina esteja envolvida no desenvolvimento de recaídas. Neste contexto, o objetivo do trabalho foi analisar a variabilidade genética de isolados de amostras pareadas infecção primária/recaídas de um mesmo paciente e investigar a associação entre a homeostase do ferro, particularmente da hepcidina e sua associação com a ativação dos hipnozoítos além de avaliar a resposta imunológica contra os principais antígenos do P. vivax. Sessenta e cinco amostras pareadas de 30 pacientes foram genotipadas utilizando 10 marcadores moleculares através de eletroforese capilar. Além disso, a presença de infecção múltipla nos pacientes foi confirmada através da clonagem dos fragmentos amplificados dos microssatélites e genotipagem a partir de diferentes colônias. Na análise baseada nos alelos predominantes foi demonstrado que os parasitos da recaída são principalmente heterólogos em relação à infecção primária e que geralmente ocorre uma flutuação entre os alelos predominantes nos diferentes episódios do indivíduo. Entretanto, o número de alelos por marcador foi limitado e geralmente os alelos foram idênticos nos diferentes episódios da doença num mesmo paciente...

A principal contribuição deste estudo foi demonstrar uma alta taxa de infecções múltiplas tanto das infecções primárias como nas recaídas, sendo que infecções múltiplas puderam ser identificadas com um mínimo de Cinco marcadores.Foram feitas dosagens bioquímicas de ferro, ferritina, níveis de hepcidina e análise de outras variáveis como hemoglobina e parasitemia dos pacientes. Houve diferença significativa entre os grupos somente na análise de níveis de hemoglobina sendo maior nas recaídas. Acredita-se que o número de amostras foi um limitante das análises estatísticas. O gene codificador da hepcidina foi sequenciado nas amostras de área sem transmissão e de área endêmica. Não foram encontrado polimorfismos nesse gene mostrando seu alto grau de conservação. Não foi observada diferença nos níveis de resposta imunológica contra os antígenos do P. vivax nas infecções primárias e recaídas. As infecções por este parasito são observadas com alta diversidade genética e com a presença de múltiplas variantes em uma mesma infecção, sendo esta, primária ou recaída da doença, variantes que podem sofrer variações em sua frequência durante a evolução da doença. Com estes resultados espera-se contribuir para o esclarecimento dos aspectos relacionados à diversidade genética dos parasitos e dos mecanismos que influenciam o desenvolvimento das recaídas do P. vivax, que poderão ajudar no seu prognóstico, direcionamento o tratamento e auxiliando no controle da doença...

Prevalence and Clinical Manifestations of Malaria in Aligarh, India

Malaria is one of the most widespread infectious diseases of tropical countries with an estimated 207 million cases globally. In India, there are endemic pockets of this disease, including Aligarh. Hundreds of Plasmodium falciparum and P. vivax cases with severe pathological conditions are recorded every year in this district. The aim of this study is to find out changes in liver enzymes and kidney markers. Specific diagnosis for P. falciparum and P. vivax was made by microscopic examination of Giemsa stained slides. Clinical symptoms were observed in both of these infections. Liver enzymes, such as AST, ALT, and ALP, and kidney function markers, such as creatinine and urea, were estimated by standard biochemical techniques. In Aligarh district, P. vivax, P. falciparum, and mixed infections were 64%, 34%, and 2%, respectively. In case of P. falciparum infection, the incidences of anemia, splenomegaly, renal failure, jaundice, and neurological sequelae were higher compared to those in P. vivax infection. Recrudescence and relapse rates were 18% and 20% in P. falciparum and P. vivax infections, respectively. Liver dysfunctions and renal failures were more common in P. falciparum patients, particularly in elderly patients. Artesunate derivatives must, therefore, be introduced for the treatment of P. falciparum as they resist to chloroquine as well as sulfadoxine-pyrimethamine combinations.

Plasmodium vivax malaria: related factors to severity in the State of Maranhão, Brazil

INTRODUCTION: Malaria caused by Plasmodium vivax species has shown signs of severity, recorded with increasing frequency in the medical literature. This study aimed to characterize the signs of severe malaria by Plasmodium vivax in the State of Maranhão, Brazil. METHODS: A descriptive cohort study of patients assisted in the field and a historical and concurrent study of a series of cases among hospitalized patients were undertaken to identify the clinical and laboratory signs of severity. RESULTS: A total of 153 patients were included in the study, 13 of whom were hospitalized. Males made up the majority, numbering 103 (67.3%). The age of the patients ranged from 10 to 70 years, 92.2% were natives of the State of Maranhão, and 65% of the patients had had malaria before. The average time elapsed between symptom onset and diagnosis among outpatients was three days, while among hospitalized patients this average reached 15.5 days, a statistically significant difference (p=0.001). The parasitemia ranged from 500 to 10,000 parasites/µl in 92.8% of cases. The clinical and laboratory manifestations of severity were vomiting and diarrhea, jaundice, drowsiness, mental confusion, seizures, loss of consciousness, agitation, bleeding, pale skin, coughing and dyspnea, thrombocytopenia, anemia, elevation of nitrogenous compounds, and elevated transaminases and bilirubin. CONCLUSIONS: The monitoring of malaria patients with Plasmodium vivax showed the possibility of aggravation, the intensity of which varied in different circumstances, especially the interval time between falling ill and diagnostic confirmation.

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.

Plasmodium Vivax Malaria Complicated by Pericardial Effusion.

We describe herein an unusual and sole cardiac complication of pericardial effusion in a case of plasmodium vivax malaria.

Retardo no crescimento intrauterino, baixo peso ao nascer e prematuridade em recém-nascidos de grávidas com malária, na Colômbia / Intrauterine growth retardation, low birth weight and prematurity in neonates of pregnant women with malaria in Colombia

INTRODUÇÃO: É frequente a associação da malária com complicações como prematuridade, retardo no crescimento intrauterino, baixo peso ao nascer e mortalidade infantil, efeitos pouco estudados em áreas hipoendêmicas para malaria. O objetivo deste estudo foi analisar a relação da malária gestacional com estes efeitos em recém-nascidosnuma região endêmica para malária na Colômbia, entre 1993 e 2007. MÉTODOS: Foram estudadas as características em 1.716 recém-nascidos num estudo de coorte. Fez-se seguimento em 394 gestantes com malária (27 por cento por Plasmodium falciparum e 73 por cento por P. vivax) e 1.322 sem malária. RESULTADOS: Foi encontrada uma relação entre a exposição à malária na gestação e o risco maior de baixo peso ao nascer (RR = 1,37; 1,03-1,83), assim como estatura baixa (RR = 1,52; 1,25-1,85), retardo no crescimento intrauterino (RR = 1,29; 1,0-1,66) e prematuridade (RR = 1,68; 1,3-2,17). A frequência de nascimentos prematuros foi maior nas mães com malária por P. falciparum (77 por cento) que aquelas com P. vivax (RR = 1,77; IC 95 por cento: 1,2-2,6). CONCLUSÕES: O baixo peso ao nascer e o retardo no crescimento foi associado com malária na gestação na Colômbia. A infecção por P. vivax foi relacionada com efeitos adversos sobre o recém-nascido, de modo semelhante em relação ao P. falciparum.

INTRODUCTION: Association between malaria and pregnancy complications, such as prematurity, intrauterine growth restriction, low birthweight and infant mortality has been reported. These effects have been studied widely in areas hyperendemic for malaria, but studies in low-endemic areas are scarce. The study investigated the relation between gestational malaria and low birthweight and intrauterine growth retardation in neonates of a malarial endemic region in Colombia, between 1993 and 2007. METHODS: The pattern of development in 1,716 neonates of women with and without malaria infection during pregnancy was evaluated in a cohort study. A total of 394 infected (27 percent by P. falciparum and 73 percent by P. vivax) and 1,322 noninfected pregnant women were followed. RESULTS: Exposure to gestational malaria was associated with increased risk of low birth weight (RR = 1.37; 1.03-1.83), short height (RR = 1.52; 1.25-1.85), intrauterine growth retardation (RR = 1.29; 1.0-1.66) and prematurity (RR = 1.68; 1.3-2.17). Prematurity was 77 percent higher in infants of mothers with malaria by P. falciparum than infants of mothers with malaria by P. vivax (RR = 1.77; 1.2-2.6). CONCLUSIONS: Low birth weight and intrauterine growth retardation were associated with malaria during pregnancy. Infection with P. vivax was related with adverse effects on the newborn, similar to that reported for P. falciparum.

Plasmodium vivax malaria: is it actually benign?

Plasmodium vivax [Pv] malaria is being increasingly recognized as a cause of severe malaria in children. To describe the various severe manifestations associated with vivax malaria by retrospective analysis of records. Children between the ages of 0 and 18 years with a confirmed diagnosis of Pv malaria monoinfection done by peripheral blood film [PBF] and/or rapid diagnostic test [RDT] admitted between June and September 2009 were included. Their clinical, hematological and biochemical manifestations were analyzed. Twenty-three patients of Pv malaria were retrospectively analyzed. Thrombocytopenia was present in 22 [96%] patients with counts less than 50,000/ micro L in 9 patients. Severe anemia [hgb < 5 mg/dl] was present in 8 [34%] patients. Cerebral malaria was present in 3 patients. Liver enzymes were elevated [>3 times normal] in 4 [17.3%] patients while jaundice [bilirubin > 2.5 mg/dl] was present in 2 patients [total bilirubin 5.2 mg/dl and 14.3 mg/dl]. Renal dysfunction [creatinine > 3 mg/dl] was present in 6 [26%] patients with 2 patients showing severely deranged renal functions [blood urea 168 mg/dl, 222 mg/dl and serum creatinine 5.0 mg/dl, 5.6 mg/dl, respectively]. Hypernatremia was present in one patient. One patient expired within 12 h of presentation because of severely deranged hepatic and renal dysfunction. Pv malaria can lead to unusual and fatal complications. All new guidelines should include "Severe Vivax malaria" as a clinical entity. Further research into the etiopathogenesis and treatment would be important

Subdoses of primaquine in overweight patients and malaria vivax relapses: report of two cases in the Federal District, Brazil / Subdoses de primaquina associadas a recaídas de malária vivax em pacientes com peso elevado: relato de dois casos no Distrito Federal

Two cases of malaria by Plasmodium vivax relapsed after treatment with drugs in doses recommended by the Ministry of Health are presented. Both patients were overweight and were followed in the Federal District, an area considered free from vector transmission of the disease. Radical cure was obtained after medication with the same drugs in weight proportional doses.

São apresentados dois casos de pacientes com malária por Plasmodium vivax que apresentaram recaídas após tratamento com medicamentos em doses indicadas pelo Ministério da Saúde. Ambos os pacientes tinham pesos elevados e foram acompanhados no Distrito Federal, área considerada sem transmissão vetorial da doença. A cura radical foi obtida após medicação em dose proporcional ao peso corpóreo dos pacientes.