Plasmodium vivax malaria admissions and risk of mortality in a tertiary-care children's hospital in North India.

Background: In 2010, there was an increase in the severity of malaria admissions to Kalawati Saran Children's Hospital, New Delhi and this report describes the morbidity and mortality profile. Method: A retrospective chart review of patients admitted with parasitologically confirmed malaria between January and December 2010. Results: There were 156 cases: P. vivax 105 (67.3%), P. falciparum 39 (25%) and mixed infections 12 (7.7%). Thrombocytopenia (platelet count <150 x 10(9)/L) was present in 90 (85.7%) patients with P. vivax mono-infection. There were 91(58.3%) patients with severe malaria: P. vivax mono-infection 46 (50.5%), P. falciparum mono-infection 35(38.5%) and mixed 10 (11%). Severe anaemia and severe thrombocytopenia (platelet count <20 x 10(9)/L) were detected significantly more often in P. falciparum and P. vivax mono-infection, respectively. Complications including cerebral malaria, acute renal failure, shock, acute respiratory distress syndrome (ARDS) and multiple-organ dysfunction syndrome (MODS) were similar in both groups. The mortality rate of around 20% was similar in severe P. vivax and P. falciparum mono-infection. Risk of mortality in vivax malaria was highest in patients with ARDS followed by MODS and shock. Conclusion: Increased morbidity owing to P. vivax malaria was observed and risk of mortality was highest in patients with ARDS and MODS.