Atypical Cases of Malaria Vivax

Abstract

SUMMARY Severe clinical presentations of vivax malaria are rare. However, in this article three atypical cases are reported. Cases 1 and 2 developed acute respiratory insufficiency and recovered from it, case 3 however, presented systemic vasculitis and pulmonary hemorrhage, passing away by the seventh day of treatment. The three cases needed intensive therapy. Hematological and biochemical exams, daily parasitemia, chest x-ray, alpha tumoral necrosis factor quantification (TNF-a) on the diagnosis day (D0) and seven days after (D7) were made. In case 3, exams to discard the possibility of bacterial and viral diseases were made. The three cases severely evolved, even after parasitemia returned negative and they presented important thrombocytopenia on D0. In case 1, the pulmonary picture improved after oxygen therapy, hydro saline restriction and maintenance of negative hydric balance by using endovenous furosemide. In case 2 a systemic antibiotic therapy due to the suspicion of bilateral pneumonia was prescribed but the patient improved only after the beginning of vivax malaria treatment. Case 3 developed a severe pulmonary hemorrhage despite intensive therapy measures and passed away by D7. TNF-a reached high levels on D0 on the three cases, probably contributing to the severe presentations. Mutation –308 was not detected on gene TNF-a promoting region on the cases. DESCRIPTORS Vivax Malaria. Complications. Alpha tumoral necrosis factor.