Diagnostic criteria for severe P. vivax malaria

The diagnosis of malaria, including P. vivax malaria, is challenging because its symptoms are similar to those of other infectious diseases.

Children also exhibit varying symptoms and clinical manifestations in comparison to adults.

Although it was previously thought that P. vivax is not associated with severe malaria, which made diagnosis and treatment challenging. However, several studies indicate that P. vivax is linked to severe malaria in endemic areas.1 It is thus important to be able to adequately diagnose severe P. vivax malaria to ensure that the right treatment is administered. 

The table below serves as a guide to determine severe P. vivax malaria based on clinical manifestations and laboratory indices. It must be noted however that since these clinical manifestations mimic those of other indications, diagnostic testing is the only method that can accurately determine the presence of P. vivax malaria.

 

Prognostic value (+ to +++)

 

Frequency (+ to +++)

Children

Adults

Clinical manifestation

Children

Adults

+++

+++

Impaired consciousness

+++

++

+++

+++

Respiratory distress (acidotic breathing)

+++

++

+

++

Multiple convulsions

+++

+

+

+

Prostration

+++

+++

+++

+++

Shock

+

+

+++

+++

Pulmonary oedema (radiological)

Infrequent

+

+++

++

Abnormal bleeding

Infrequent

+

++

+

Jaundice

+

++

 

 

Laboratory indices

 

 

+

+

Severe anaemia

+++

+

+++

+++

Hypoglycaemia

+++

++

+++

+++

Acidosis

+++

++

+++

+++

Hyperlactataemia

+++

++

++

++

Renal impairment (acute kidney injury)

+

+++

Source: WHO (2014). Severe Malaria. Trop Med Int Health; 19 Suppl.:7–131
.