# name
Characterization of Plasmodium vivax-associated admissions to
                reference hospitals in Brazil and India

# metadata.dc.description.abstract[].value
BACKGROUND: The benign character formerly attributed to
                Plasmodium vivax infection has been dismantled by the increasing
                number of reports of severe disease associated with infection
                with this parasite, prompting the need for more thorough and
                comprehensive characterization of the spectrum of resulting
                clinical complications. Endemic areas exhibit wide variations
                regarding severe disease frequency. This study, conducted
                simultaneously in Brazil and India, constitutes, to our
                knowledge, the first multisite study focused on clinical
                characterization of P. vivax severe disease. METHODS: Patients
                admitted with P. vivax mono-infection at reference centers in
                Manaus (Amazon - Brazil) and Bikaner (Rajasthan - India), where
                P. vivax predominates, were submitted to standard thorough
                clinical and laboratory evaluations in order to characterize
                clinical manifestations and identify concurrent co-morbidities.
                RESULTS: In total, 778 patients (88.0% above 12 years old) were
                hospitalized at clinical discretion with PCR-confirmed P. vivax
                mono-infection (316 in Manaus and 462 in Bikaner), of which 197
                (25.3%) presented at least one severity criterion as defined by
                the World Health Organization (2010). Hyperlactatemia,
                respiratory distress, hypoglycemia, and disseminated
                intravascular coagulation were more frequent in Manaus.
                Noteworthy, pregnancy status was associated as a risk factor for
                severe disease (OR = 2.03; 95% CI = 1.2-3.4; P = 0.007). The
                overall case fatality rate was 0.3/1,000 cases in Manaus and
                6.1/1,000 cases in Bikaner, with all deaths occurring among
                patients fulfilling at least one severity criterion. Within this
                subgroup, case fatality rates increased respectively to 7.5% in
                Manaus and 4.4% in Bikaner. CONCLUSION: P. vivax-associated
                severity is not negligible, and although lethality observed for
                complicated cases was similar, the overall fatality rate was
                about 20-fold higher in India compared to Brazil, highlighting
                the variability observed in different settings. Our observations
                highlight that pregnant women and patients with co-morbidities
                need special attention when infected by this parasite due to
                higher risk of complications.

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Characterization of Plasmodium vivax-associated admissions to
                reference hospitals in Brazil and India