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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 BegComments to Author 
Author affiliations: Aga Khan University, Karachi, Pakistan (A.B.S. Zubairi, S. Nizami, A. Raza, A.F. Rasheed, N.K. Ghanchi, Z.N. Khaled, M.A. Beg); Aix Marseille Université, Marseille, France (V. Mehraj)

Main Article

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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References
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Page created: October 31, 2013
Page updated: October 31, 2013
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