ABSTRACT

The mounting evidence supporting the capacity of Plasmodium vivax to cause severe disease has prompted the need for a better characterization of the resulting clinical complications. India is making progress with reducing malaria, but epidemics of severe vivax malaria in Gujarat, one of the main contributors to the vivax malaria burden in the country, have been reported recently and may be the result of a decrease in transmission and immune development. Over a period of one year, we enrolled severe malaria patients admitted at the Civil Hospital in Ahmedabad, the largest city in Gujarat, to investigate the morbidity of severe vivax malaria compared to severe falciparum malaria. Patients were submitted to standard thorough clinical and laboratory investigations and only PCR-confirmed infections were selected for the present study. Severevivax malaria (30 patients) was more frequent than severe falciparum malaria (8 patients) in our setting, and it predominantly affected adults (median age 32 years, interquartile range 22.5 years). This suggests a potential age shift in anti-malarial immunity, likely to result from the recent decrease in transmission across India. The clinical presentation of severe vivax patients was in line with previous reports, with jaundice as the most common complication. Our findings further support the need for epidemiological studies combining clinical characterization of severe vivax malaria and serological evaluation of exposure markers to monitor the impact of elimination programmes.

 抽象的

越来越多的证据支持间日疟原虫能够引起严重疾病，这促使我们需要更好地描述由此产生的临床并发症。印度在减少疟疾方面正在取得进展，但最近报道了古吉拉特邦严重间日疟疾的流行，古吉拉特邦是该国间日疟疾负担的主要原因之一，这可能是传播和免疫发育下降的结果。在一年的时间里，我们招募了古吉拉特邦最大城市艾哈迈达巴德民用医院收治的重症疟疾患者，以调查重症间日疟疾与重症恶性疟疾的发病率。患者接受了标准的、彻底的临床和实验室调查，并且仅选择 PCR 确诊的感染用于本研究。在我们的环境中，严重疟疾（30 名患者）比严重恶性疟疾（8 名患者）更常见，并且主要影响成年人（中位年龄 32 岁，四分位距 22.5 岁）。这表明抗疟疾免疫力可能出现年龄变化，这可能是由于最近印度各地传播减少所致。重症间日疟患者的临床表现与既往报道一致，其中黄疸是最常见的并发症。我们的研究结果进一步支持流行病学研究的必要性，结合严重间日疟疾的临床特征和暴露标记物的血清学评估，以监测消除计划的影响。