Volume 19, Number 11—November 2013
Dispatch
Severe Plasmodium vivax Malaria in Pakistan
Ali Bin Sarwar Zubairi, Sobia Nizami, Afsheen Raza, Vikram Mehraj, Anita Fazal Rasheed, Najia Karim Ghanchi, Zahra Nur Khaled, and M. Asim Beg
Table 2
Comparison of complication rates in P. falciparum versus P. vivax infections, Karachi, Pakistan, 2009–20011*
| Complications |
Case definition |
No. (%) P. falciparum cases; n = 47 |
No. (%) P. vivax cases; n = 296 |
Odds ratio (CI) |
p value |
||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| WHO criteria† | |||||||||||
| Altered consciousness | Disorientation or confusion | 5 (10.6) | 6 (2.0) | 5.7 (1.7–19.7) | 0.002 | ||||||
| Metabolic acidosis | Plasma bicarbonate <15 mmol/L | 5 (10.6) | 17 (5.7) | 1.9 (0.7–5.6) | 0.203 | ||||||
| Pulmonary edema | Respiratory distress and bilateral diffuse infiltrates on chest radiograph | 6 (12.8) | 23 (7.8) | 1.7 (0.7–4.5) | 0.253 | ||||||
| Abnormal spontaneous bleeding | Bleeding from gastrointestinal, genitourinary or respiratory tracts | 1 (2.1) | 16 (5.4) | 0.4 (0.049–2.9) | 0.336 | ||||||
| Jaundice | Serum bilirubin >3.0 mg/dL | 12 (25.5) | 28(9.5) | 3.3(1.5–7.0) | 0.001 | ||||||
| Hemoglobinuria | Hemoglobin in urine | 15 (31.9) | 62 (20.9) | 1.8 (0.9–3.4) | 0.094 | ||||||
| Shock | Systolic blood pressure <80 mm Hg | 4 (8.5) | 5 (1.7) | 5.4 (1.4–20.9) | 0.007 | ||||||
| Hypoglycemia‡ | Blood glucose <40 mg/dL | 1 (2.1) | 3 (1.0) | 2.1 (0.2–20.9) | 0.509 | ||||||
| Renal impairment§ | Serum creatinine >3 mg/dL | 2 (4.3) | 10 (3.4) | 1.3 (0.3–6.0) | 0.761 | ||||||
| Other | |||||||||||
| Hyperpyrexia | Core body temperature >40°C | 4 (8.5) | 32 (10.8) | 0.8 (0.4–1.9) | 0.416 | ||||||
| Thrombocytopenia | Platelets <150,000/mm3 | 39 (83.0) | 272 (91.9) | 0.4 (0.2–1.0) | 0.051 | ||||||
| Profound | <20,000/mm3 | 5 (10.6) | 58 (19.6) | 0.5 (0.2–1.0) | 0.141 | ||||||
| Anemia | Hemoglobin <7 mg/dL | 10 (21.3) | 15 (5.1) | 5.0 (2.1–12.1) | 0.000 | ||||||
| Multiorgan dysfunction | Biochemical and /or radiographic evidence of ≥2 organs involved | 5 (10.6) | 21 (7.1) | 1.6 (0.6–4.4) | 0.394 | ||||||
| Secondary infection | Radiographic/microbiological evidence of infection | 9 (19.1) | 2 (7.4) | 2.9 (1.3–6.9) | 0.009 | ||||||
| Coagulopathy | Deranged PT/APTT | 5 (10.6) | 17 (5.7) | 2.0 (0.7–5.6) | 0.203 | ||||||
| Liver dysfunction | ALT level >normal | 16 (44.4) | 97 (40.9) | 1.1 (0.5–1.9) | 0.690 | ||||||
*WHO, World Health Organization; PT, prothrombin time; APTT, activated partial thromboplastin time. ALT, alanine aminotransferase.
†Source: (4).
‡Patients with preexisting diabetes were excluded from this count; n = 303.
§Patients with preexisting chronic kidney disease were excluded from this count; n = 343.
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