Clinical and epidemiological characterization of severe Plasmodium vivax malaria in Gujarat, India

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.

KEYWORDS:

• Severe malaria
• Plasmodium vivax
• Gujarat
• India
• malaria elimination

Acknowledgments

We thank the staff of the Ahmedabad Civil hospital, as well as Drs Lalitha Ramanathapuram and Annie Kessler for their logistical support. We also thank Dr.NeenaValecha, the former Director of ICMR-NIMR for facilitating the study, and the staff of the NIMR Field Unit Nadiad for their participation. The research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number U19AI089676 as part of the International Centers for Excellence in Malaria Research. SCW is supported by a grant from the UK Medical Research Council, award number MR/S009450/1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Disclosure statement

The authors have no conflict of interest to declare.

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Funding

This work was supported by the National Institute of Allergy and Infectious Diseases [U19AI089676].