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Volume 11, Number 1—January 2005

Dispatch

Plasmodium vivax Malaria

Dhanpat K. Kochar*Comments to Author , Vishal Saxena†, Narvachan Singh*, Sanjay K. Kochar*, S. Vijay Kumar†, and Ashis Das†
Author affiliations: *Sardar Patel Medical College, Bikaner, Rajasthan, India; †Birla Institute of Technology and Science, Pilani, Rajasthan, India

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Table 1

Clinical characteristics of severe vivax malaria patients

Patient No. Age (y)/sex Clinical 
presentation* Parasitemia (density) 
(P. vivax/mm3) Diagnostic tests for malaria
Other relevant information Outcome
PBF RMDT OptiMAL test† PCR
1 30, F ARDS 6,000 + Positive + Skiagram chest suggestive of pulmonary edema Died
2 17, M Renal failure, bleeding diathesis 20,000 + Positive + PT >60 (Control – 16)
BT, CT, PT – N Recovered
3 53, M Jaundice‡ 35,000 + Positive + Epistaxis, hemoglobinurea
BT, CT, PT – N Recovered
4 20, F Cerebral (GCS– 3) anemia, ARDS, PCF 15,000 + Positive + BP <70 mmHg (systolic)
CSF – N
CT scan head – could not be done Died within 5 of admission
5 45, M Renal failure, jaundice‡ 36,000 + Positive + Recovered
6 22, F Cerebral 
(GCS – 6) anemia 8,000 + Positive + Puerpural period 3rd gravida
CSF – N
CT scan head – N Recovered
Baby died on 14th day at residence
7 18, F Cerebral 
(GCS – 5) anemia 10,000 + Positive + Primigravida
CSF – Normal
CT scan head – N Recovered
PMNS - Psychosis
Premature delivery
Baby survived
8 28, F Renal failure, ARDS, PCF 44,000 + Positive + Gross hematuria
BP <70 mm Hg systolic Recovered
9 25, F Jaundice‡, haemoglobinurea 90,400 + Positive + Secondgravida Recovered
Pregnancy continued
10 50, M Jaundice‡ 18,000 + Positive + Recovered
11 18, F Renal failure, anemia, pulmonary edema 34,000 + Positive + Skiagram chest – pulmonary edema Recovered
Underwent hemodialysis

*All patients were fully conscious except patients 4, 6, and 7. ALT, alanine aminotransferase; ARDS, acute respiratory distress syndrome; AST, aspartate aminotransferase; BT, bleeding time; CT, clotting time; CT, computerized tomography scan of head (non-contrast); F, female; GCS, Glasgow coma scale; LDH, lactate dehydrogenase; M, male; N, normal; PBF, peripheral blood film; PCR, polymerase chain reaction; PMNS, post malarial neurologic syndrome; PT, prothrombin time; TLC, total leukocyte count; RMDT, rapid malaria diagnostic test.
†Positive for Plasmodium vivax, malariae, or ovale because of common LDH isoenzyme antigen and negative for P. falciparum.
‡Relevant investigations were done to rule out viral hepatitis and leptospirosis in all patients with jaundice.

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