Severe Plasmodium vivax Malaria: Fact or Fiction
TO THE EDITOR—Lacerda and colleagues should be congratulated for their excellent and timely autopsy study of patients who died with a diagnosis of Plasmodium vivax malaria in a tertiary care hospital in the Brazilian Amazon [1]. There have been increasing reports in the medical literature of single cases, case series, hospital-based studies, and reviews of severe and sometimes fatal malaria caused by P. vivax [2–25]. Autopsy studies are still essential to exclude confounding factors such as parasitological misdiagnosis, concurrent infections, and underlying diseases that can bias the majority of the published studies on severe P. vivax malaria [4, 7, 8, 15–22, 25].
However, the abovementioned reports have questioned the paradigm of benign P. vivax malaria and should prompt at least 2 questions: (1) Is an increasingly virulent P. vivax responsible for the emergence of the “new” severe clinical picture? (2) What are the characteristics of P. vivax malaria when it is severe or associated with numerous complications?
In the outstanding book, “Bruce-Chwatt's Essential Malariology,” Warrell notes other conditions that are connected to P. vivax malaria: “ … severe vivax malaria has been described in the past (for example in Europe) possibly related to malnutrition and other intercurrent diseases”; … ”Mild anemia is a common result of vivax malaria but it may become severe and even life-threatening in children and debilitated patients after relapsing infections. ...........
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