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Plasmodium vivax malaria: Is it actually benign?
Journal of Infection and Public Health (2012) 5, 317
LETTER TO EDITOR Plasmodium vivax malaria: Is it actually benign?
a confounding variable and the future studies may require taking care of this fact.
Sir, I read the article ‘Plasmodium vivax malaria: is it actually benign?’ [1] with interest. In this article, Harpal Singh et al. have carried out a retrospective analysis of clinical, haematological and biochemical profile of children with a confirmed diagnosis of Plasmodium vivax malaria. The authors included 108 patients with the diagnosis of Plasmodium vivax in their study between the months of June and September 2009. Out of these, 23 patients were identified with severe manifestations of malaria and their medical records were retrospectively analyzed. Curiously the authors have calculated the occurrences of each of the severe manifestations out of 23 rather than the total number of Plasmodium vivax patients, i.e. 108. This gives a false impression of severity with very high percentages. It has also been mentioned that 70% of the children had moderate malnutrition as per the WHO classification. Fillol et al. have reported down regulation of anti-Plasmodium falciparum antibody response in malnourished children [2]. Lack of antibody response may lead to higher risk of infection. However, results of community based studies have been conflicting. Whereas, few studies reveal increased malarial morbidity with stunting [3,4], others highlight that stunting offer protection to children from malaria [5]. Type of malnourishment may also be important in deciding immune response, since stunting and not wasting induces down regulation of IgG antibody response [2]. In the present study malnutrition may have played as
Conflict of interest We have no conflict of interest to declare.
References [1] Singh H, Parakh A, Basu S, Rath B. Plasmodium vivax malaria: is it actually benign? J Infect Public Health 2011;4(June (2)):91—5. [2] Fillol F, Sarr JB, Boulanger D, Cisse B, Sokhna C, Riveau G, et al. Impact of child malnutrition on the specific anti-Plasmodium falciparum antibody response. Malar J 2009;8(June):116. [3] Deen JL, Walraven GE, von Seidlein L. Increased risk for malaria in chronically malnourished children under 5 years of age in rural Gambia. J Trop Pediatr 2002;48(April (2)):78—83. [4] Friedman JF, Kwena AM, Mirel LB, Kariuki SK, Terlouw DJ, Phillips-Howard PA, et al. Malaria and nutritional status among pre-school children: results from cross-sectional surveys in western Kenya. Am J Trop Med Hyg 2005;73(October (4)):698—704. [5] Genton B, Al-Yaman F, Ginny M, Taraika J, Alpers MP. Relation of anthropometry to malaria morbidity and immunity in Papua New Guinean children. Am J Clin Nutr 1998;68(September (3)):734—41.
Sameer Gulati ∗ Internal Medicine, St Stephen’s Hospital, Tis Hazari, Delhi, India ∗ Tel.: +91 9873082208. E-mail address: [email protected]
Available online at www.sciencedirect.com
1876-0341/$ — see front matter © 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.jiph.2011.09.004
19 July 2011
LETTER TO EDITOR Plasmodium vivax malaria: Is it actually benign?
a confounding variable and the future studies may require taking care of this fact.
Sir, I read the article ‘Plasmodium vivax malaria: is it actually benign?’ [1] with interest. In this article, Harpal Singh et al. have carried out a retrospective analysis of clinical, haematological and biochemical profile of children with a confirmed diagnosis of Plasmodium vivax malaria. The authors included 108 patients with the diagnosis of Plasmodium vivax in their study between the months of June and September 2009. Out of these, 23 patients were identified with severe manifestations of malaria and their medical records were retrospectively analyzed. Curiously the authors have calculated the occurrences of each of the severe manifestations out of 23 rather than the total number of Plasmodium vivax patients, i.e. 108. This gives a false impression of severity with very high percentages. It has also been mentioned that 70% of the children had moderate malnutrition as per the WHO classification. Fillol et al. have reported down regulation of anti-Plasmodium falciparum antibody response in malnourished children [2]. Lack of antibody response may lead to higher risk of infection. However, results of community based studies have been conflicting. Whereas, few studies reveal increased malarial morbidity with stunting [3,4], others highlight that stunting offer protection to children from malaria [5]. Type of malnourishment may also be important in deciding immune response, since stunting and not wasting induces down regulation of IgG antibody response [2]. In the present study malnutrition may have played as
Conflict of interest We have no conflict of interest to declare.
References [1] Singh H, Parakh A, Basu S, Rath B. Plasmodium vivax malaria: is it actually benign? J Infect Public Health 2011;4(June (2)):91—5. [2] Fillol F, Sarr JB, Boulanger D, Cisse B, Sokhna C, Riveau G, et al. Impact of child malnutrition on the specific anti-Plasmodium falciparum antibody response. Malar J 2009;8(June):116. [3] Deen JL, Walraven GE, von Seidlein L. Increased risk for malaria in chronically malnourished children under 5 years of age in rural Gambia. J Trop Pediatr 2002;48(April (2)):78—83. [4] Friedman JF, Kwena AM, Mirel LB, Kariuki SK, Terlouw DJ, Phillips-Howard PA, et al. Malaria and nutritional status among pre-school children: results from cross-sectional surveys in western Kenya. Am J Trop Med Hyg 2005;73(October (4)):698—704. [5] Genton B, Al-Yaman F, Ginny M, Taraika J, Alpers MP. Relation of anthropometry to malaria morbidity and immunity in Papua New Guinean children. Am J Clin Nutr 1998;68(September (3)):734—41.
Sameer Gulati ∗ Internal Medicine, St Stephen’s Hospital, Tis Hazari, Delhi, India ∗ Tel.: +91 9873082208. E-mail address: [email protected]
Available online at www.sciencedirect.com
1876-0341/$ — see front matter © 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.jiph.2011.09.004
19 July 2011