Publication: Uncomplicated Plasmodium vivax malaria in pregnancy associated with mortality from acute respiratory distress syndrome
Issued Date
2014
Resource Type
Language
eng
Rights
Mahidol University
Rights Holder(s)
BioMed Central
Bibliographic Citation
Malaria Journal. Vol.13, (2014), 191
Suggested Citation
McGready, Rose, Klanarong Wongsaen, Chu, Cindy S, Tun, Nay Win, Kesinee Chotivanich, White, Nicholas J, François Nosten Uncomplicated Plasmodium vivax malaria in pregnancy associated with mortality from acute respiratory distress syndrome. Malaria Journal. Vol.13, (2014), 191. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/3075
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Uncomplicated Plasmodium vivax malaria in pregnancy associated with mortality from acute respiratory distress syndrome
Abstract
The association between severe malaria and Plasmodium vivax species is contentious. On the Thai-Myanmar border, all
pregnant women are followed systematically with active weekly malaria screening. Over a 27-year period of providing
antenatal care, 48,983 have been prospectively followed until pregnancy outcome (miscarriage or delivery) and 4,298
women have had P. vivax detected at least once. Reported here is the first known P. vivax-associated death amongst
these women. The initial patient presentation was of uncomplicated P. vivax (0.5% parasitaemia) in a term, multigravida
woman who responded rapidly to oral artesunate and mefloquine treatment, clearing her blood stage parasites within
48 hours. The patient appeared well, was ambulatory and due to be discharged but became unwell with acute
respiratory distress syndrome (ARDS) requiring ventilation three days (67 hours) into treatment. Despite induction and
delivery of a stillborn foetus, ventilatory requirements increased and the patient died on day 7. The patient had a low
body mass index. Sensitive detection with nested PCR confirmed only the presence of P. vivax species and concomitant
infections such as tuberculosis and human immunodeficiency virus (HIV) were also ruled out. The contemporaneous
treatment of acute uncomplicated P. vivax and the onset of ARDS on day 3 in this patient implies a possible but
unconfirmed association with death in this patient. Assuming this death was caused by P. vivax, the risk of ARDS-related
maternal mortality in this setting did not differ significantly between Plasmodium falciparum and P. vivax (0.24 per 1,000
(1/4,158) versus 0.23 per 1,000 (1/4,298), contrary to the increased risk of maternal mortality from P. falciparum compared
to P. vivax, 2.89 per 1,000 (12/4,158) versus 0.23 per 1,000 (1/4,298), P = 0.003.