P. vivax Malaria, Brazilian Amazon | CDC EID

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Volume 16, Number 10–October 2010
Dispatch
Severe Plasmodium vivax Malaria, Brazilian Amazon

Márcia A. Alexandre, Cynthia O. Ferreira, André M. Siqueira, Belisa L. Magalhães, Maria Paula G. Mourão, Marcus V. Lacerda Comments to Author, and Maria das Graças C. Alecrim
Author affiliations: Fundação de Medicina Tropical do Amazonas, Manaus, Brazil (M.A. Alexandre, C.O. Ferreira, M.P.G. Mourão, M.V. Lacerda); Universidade do Estado do Amazonas, Manaus (M.A. Alexandre, A.M. Siqueira, B.L. Magalhães, M.P.G. Mourão, M.V. Lacerda, M.G.C. Alecrim); and Centro Universitário Nilton Lins, Manaus (M.A. Alexandre, A.M. Siqueira, M.P.G. Mourão, M.V. Lacerda, M.G.C. Alecrim)

Suggested citation for this article

Abstract
We describe a case series of 17 patients hospitalized in Manaus (western Brazilian Amazon) with PCR-confirmed Plasmodium vivax infection who were treated with chloroquine and primaquine. The major complications were jaundice and severe anemia. No in vivo chloroquine resistance was detected. These data help characterize the clinical profile of severe P. vivax malaria in Latin America.

During 2000–2007, in Latin America, a total of 7,554,993 cases of malaria were recorded; 5,507,167 (72.9%) of these cases were caused by Plasmodium vivax parasites. Of the P. vivax malaria cases, 3,833,477 were reported in Brazil, mainly in the Amazon Region (1). Official data from the Brazilian Ministry of Health identify Manaus as one of the leading cities in terms of number of P. vivax malaria cases in Latin America (2).

Manaus (population 1,738,641 in 2009), the capital of the state of Amazonas in the western Brazilian Amazon, is clearly part of a new frontier in the economic development of the Amazon. In 2009, a total of 19,698 cases of malaria were reported in Manaus (annual parasitary index 11.3/1,000 population; 92.6% caused by P. vivax). Since the mid-1990s, as P. vivax was becoming the predominant malaria species in Brazil (3), severe cases and even deaths attributable to P. vivax infection have been reported anecdotally (3). A concomitant trend of increased hospitalization of P. vivax–infected patients was seen in a Manaus tertiary care center (4).

In 2000, one of the authors noted the increased clinical severity of P. vivax cases seen in this same hospital; the frequency of hospitalization was very similar to that of patients infected with P. falciparum (M.G.C.A., unpub. data). Other reports from the same reference center in Manaus have been published regarding unusual complications of P. vivax infection, such as severe rhabdomyolysis (5) and immune thrombocytopenic purpura (6). At the same time, a cascade of reports from areas where P. vivax malaria is highly endemic confirmed the clinical severity of the infections (7). However, to date, data are lacking on the distribution of severe P. vivax malaria, the relationship of patient age, and the identification of possible risk factors. This study describes the clinical features of P. vivax malaria in a case series of patients who were hospitalized in a tertiary care unit in the Brazilian Amazon and their clinical response to treatment with chloroquine.

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P. vivax Malaria, Brazilian Amazon | CDC EID

Suggested Citation for this Article

Alexandre MA, Ferreira CO, Siqueira AM, Magalhães BL, Mourão MPG, Lacerda MV, et al. Severe Plasmodium vivax malaria, Brazilian Amazon. Emerg Infect Dis [serial on the Internet]. 2010 Oct [date cited].
http://www.cdc.gov/EID/content/16/10/1611.htm

DOI: 10.3201/eid1610.100685

Comments to the Authors

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Address for correspondence: Marcus V. Lacerda, Fundação de Medicina Tropical do Amazonas, Av Pedro Teixeira, 25, Manaus, Amazonas 69040–000, Brazil; email: marcuslacerda.br@gmail.com