A prospective comparative study of clinical profile and severity of plasmodium falciparum and plasmodium vivax in coastal Andhra Pradesh, India


  • Rukmini Ramya M.
  • Rajya Lakshmi M. Department of General Medicine, Rangaraya Medical College, Kakinada, Andhra Pradesh, India




Clinical profile, Plasmodium falciparum, Plasmodium vivax, Severity


Background: Plasmodium falciparum (P. falciparum) causes vital organ dysfunction. The manifestation of severe form of falciparum malaria includes cerebral malaria, acidosis, severe anaemia, renal failure, hypotension, shock, disseminated intravascular coagulation and convulsion. Death rate used to be high. But vivax malaria is not presented in severe form and there is tendency of recurrence. Present study has been designed to compare clinical profile and severity of P. falciparum and Plasmodium vivax (P. vivax) malaria in coastal district of Andhra Pradesh.

Methods: Present study is a prospective comparative randomized observational study conducted in the depart of general medicine Rangaraya Medical College, Kakinada, Andhra Pradesh from February 2016 to May 2018. The study population include 260 patients diagnosed to have P. falciparum and P. vivax malaria and being admitted in the general medicine dept. Govt medical college Kakinada randomly selected based on exclusion and inclusion criteria.

Results: Out of 172 Falciparum malaria patients’ anaemia was present in 39.53% patient and out of 88 P. vivax patients 43.18% patients have anaemia. Thrombocytopenia was present in 19.76% patients of falciparum malaria and 79.54% of P. vivax. Increased leucocyte count was seen in 29.65% P. falciparum and 4.54% P. vivax patients. Leukopenia was seen in 9.3% P. falciparum and 1.136% P. vivax patient. PT and APTT was increased in 12.79% patients of P. falciparum malaria and 6.8% patients of P. vivax malaria. Liver enzyme was elevated in 27.9% of P. falciparum patients and 47.72% patients of P. vivax patients. Raised serum urea and creatinine, was seen in 18.60% patients of P. falciparum and 18.18% patients of P. vivax malaria. Electrolyte imbalance was also found in both groups.

Conclusions: - In present study number of falciparum malaria cases were more than vivax with male predominance. Hepatomegaly was more common falciparum, but splenomegaly was more common in vivax malaria patients. Anaemia and thrombocytopenia were more common in P. vivax malaria patients. Elevated liver enzyme was more common in P. vivax patients but elevated serum urea and creatinine was almost same in both groups. Except hepatic dysfunction all other complication was more in falciparum then vivax infection. Death was only marginally high in falciparum then vivax malaria patients.


WHO. World Malaria Report. WHO. 2017. Available at http://www.who.int/malaria/publications/world-malaria-report-2017/en/.

World health organisation at India. 2018. Available at http://www.searo.who.int/india/topics/malaria/about_malaria/en/.

Kochar DK, Das A, Kochar SK, Saxena V, Sirohi P, Garg S, et al. Severe Plasmodium vivax malaria: a report on serial cases from Bikaner in northwestern India. Am J Trop Med Hygiene. 2009 Feb 1;80(2):194-8.

White NJ, Breman JG. Malaria, Harrisons principal of internal medicine. Mc Graw Hill education; 19th Ed. 2015(2):1368-75.

Mohapatra MK, Padhiary KN, Mishra DP, Sethy G. Atypical manifestations of Plasmodium vivax malaria. Indian J Malario. 2002 Mar-Jun;39(1-2):18-25.

Mohapatra MK, Dash LK, Mohapatra A. Severe vivax malaria: a study on its clinical manifestations, risk factors, outcome and therapeutic efficacy of artesunate. Int J Clin Case Reports. 2013 Mar 8;3.

Directorate of National Vector Borne Disease Control Programme. Malaria situation in India. April 2018. Available at http://nvbdcp.gov.in/WriteReadData/l892s/87076468851530100944.pdf.

Gupta S, Gunter JT, Novak RJ, Regens JL. Patterns of Plasmodium vivax and Plasmodium falciparum malaria underscore importance of data collection from private health care facilities in India. Malaria J. 2009 Dec;8(1):227.

Mitra S, Abhilash KP, Arora S, Miraclin A. A prospective study from south India to compare the severity of malaria caused by Plasmodium vivax, P. falciparum and dual infection. J Vector Borne Dis. 2015 Dec 1;52(4):281.

Singh SP, Singh R, Ahmad N. A comparative study of complications of vivax and falciparum malaria in Dehradun, India. Int J Res Med Sci. 2017 Jan 20;2(1):117-21.

Barber BE, William T, Grigg MJ, Menon J, Auburn S, Marfurt J, et al. A prospective comparative study of knowlesi, falciparum, and vivax malaria in Sabah, Malaysia: high proportion with severe disease from Plasmodium knowlesi and Plasmodium vivax but no mortality with early referral and artesunate therapy. Clin Infectious Dis. 2012 Oct 19;56(3):383-97.

Singh R, Kumar S, Rana SK, Thakur B, Singh SP. A comparative study of clinical profiles of vivax and falciparum malaria in children at a tertiary care centre in Uttarakhand. J Clin Diag Res. 2013 Oct;7(10):2234.

Douglas NM, Anstey NM, Buffet PA, Poespoprodjo JR, Yeo TW, White NJ, Price RN. The anaemia of Plasmodium vivax malaria. Malaria J. 2012 Dec;11(1):135.

Limaye CS, Londhey VA, Nabar ST. The study of complications of vivax malaria in comparison with falciparum malaria in Mumbai. J Assoc Physicians India. 2012 Oct;60(60):15-8.

Goyal JP, Makwana AM. Comparison of clinical profile between P. vivax and P. falciparum malaria in children: a tertiary care centre perspective from India. Malaria Res Treatm. 2014;2014.

Ali E, Abdelrahman E. Haematological parameters and some coagulation profile in malaria patients, Eur J Biomed Pharmaceut Sci. 2017;4(4):148-52.

Mohapatra S, Samantaray JC, Arulselvi S, Ghosh A. Disseminated intravascular coagulation following malaria due to Plasmodium vivax: a thromboelastography-based study. Malaria J. 2013 Dec;12(1):336.

Asima RA, Akhtar S, Nawaz SK, Irfan S, Sadia AZ, Arshad M. Electrolyte Disturbance and the Type of Malarial Infection. Iranian J Public Health. 2015 Nov;44(11):1492.

Jasani JH, Sancheti SM, Gheewala BS, Bhuva KV, Doctor VS, Vacchani AB, et al. Association of the electrolyte disturbances (Na+, K+) with the type and severity of the malarial parasitic infection. J Clin Diagn Res. 2012;6:678-81.

Pukrittayakamee S, Chantra A, Vanijanonta S, White NJ. Pulmonary oedema in vivax malaria. Transactions Royal Soc Tropical Med Hygiene. 1998 Jul 1;92(4):421-2.

Anstey NM, Jacups SP, Cain T, Pearson T, Ziesing PJ, Fisher DA, et al. Pulmonary manifestations of uncomplicated falciparum and vivax malaria: cough, small airways obstruction, impaired gas transfer, and increased pulmonary phagocytic activity. J Infectious Dis. 2002 May 1;185(9):1326-34.

Saravu K, Rishikesh K, Kamath A, Shastry AB. Severity in Plasmodium vivax malaria claiming global vigilance and exploration - a tertiary care centre-based cohort study. Malaria J. 2014 Dec;13(1):304.

Limaye CS, Londhey VA, Nabar ST. The study of complications of vivax malaria in comparison with falciparum malaria in Mumbai. J Assoc Physicians India. 2012 Oct;60(60):15-8.

Imtiaz S, Drohlia MF, Nasir K, Hussain M, Ahmad A. Morbidity and mortality associated with Plasmodium vivax and Plasmodium falciparum infection in a tertiary care kidney hospital. Saudi J Kidney Dis Transpl. 2015;26(6):1169-76.






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