Worldwide malaria affects both children and adults, and it is known that
clinical picture varies considerably in severity depending upon the immune
status (particularly among children) and the infecting Plasmodium species. In
the present investigation it was attempted to assess epidemiological, clinical,
and laboratorial parameters of Plamodium vivax malaria during childhood and
adolescence. In this study, between January, 1995 and November, 1996, it was
enrolled 100 patients (both sexes), aged 0 to 14 years, who sought for medical
treatment in the attendance outpacient unit of the Malaria Program of Evandro
Chagas Institute, in Belem, Para State. All patients had a P. vivax-positive thick
blood film. Regarding age, malaria were more frequently seen in adolescents,
accounting for 37.0% of them. The fact that 34.0% of patients were identified as
autochthonous cases of malaria indicates that disease is progressing in urban
settings of the Amazon Region. Fever was found to be the earliest more
frequent symptom in the course of illness, being recorded in 88.0% of children.
At the first patients's attendance (Day 0, DO), fever, chill and headache
(malarial triad) were noted in 97.0%, 91.0% and 85.0% of cases, respectively;
while, hepatomegaly and splenomegaly were recorded in 29.0% and 46.0% of
them, respectively. Pallor was found to be significantly associated with anaemia
(p< 0.05), in that 89.2% of pale children had low haemoglobin values. It is likely
that anaemia has developed mainly as a result of haemolysis; although the
delay in making the malaria diagnosis (an average of 12.5 days after onset of
clinical symptoms) and concurrent hookworm intestinal parasitism may also
have played a role in its pathogenesis. An additional finding from this study
was that malnutrition seemed not to be associated with anaemia. Once
treatment had iniciated, the malarial triad began to subside and asexual
parasitaemia levels tended to decrease. The former parameter, however, was
shown to be more evident than the latter one. Other clinical symptoms such as
pallor, weakness, arthralgia, headache and dark urine lasted longer than did
malarial triad, usually persisting for up to 14 days. During or soon after finishing
treatment, complications were noted in 5.0% of children including: pneumonia,
bronchopneumonia, impetigo, gastroenteritis and a rash of unknown etiology. A
finding of practical interest is that ultrasonography was shown to be more
sensitive than abdominal palpation in the detection of hepatoesplenomegaly.
The start of drug therapy was followed by a progressive increase in
haemoglobin levels, reticulocyte count and mean corpuscular haemoglobin
concentration (MCHC) from DO (first day of treatment) to 07 (eighth day of
treatment). Conversely, the mean corpuscular haemoglobin concentration
values decreased significantly from D0 to 07, probably because iron was
present in bone marrow in decreased amounts.
|
