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Plasmodium
vivax malaria is usually more common than P. falciparum malaria and rarely
causes any complications. Also, almost all cases of P. vivax malaria respond to
Chloroquine and resistance to this drug has been reported only in sporadic cases in Irian
Jaya, Myanmar, Papua New Guinea and Vanuatu. Therefore, P. vivax malaria should
be treated with chloroquine and primaquine ONLY.
However, in areas where P. falciparum malaria is also seen in
significant numbers, there is always a chance of mixed infection. Further, in some cases,
the tests for malarial parasite may reveal only P. vivax infection. This is
particularly important if QBC method has been used for identifying the infection, wherein
species identification is rather difficult. Therefore, all cases of P. vivax
malaria should be carefully observed during initial stages of treatment and if there are
any signs of not improving or deterioration, a possible co-infection with P.
falciparum should be considered.
After 6
days of treatment, a repeat test for malarial parasites should be done to confirm
clearance of parasitemia.
Treatment of P.
vivax malaria: A flow chart
Chloroquine + Primaquine |
|
|
After 48 hours |
|
|
|
 |
 |
|
| Clinical Recovery |
Status quo / worse |
Continue the treatment
Repeat the MP test on the 6th day |
Suspect P. falciparum, repeat MP
test at 48 hrs.
(A thin smear examination is better for species identification and for assessing parasite
count) |
|
|
|
|
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NEGATIVE
|
POSITIVE
|
POSITIVE |
NEGATIVE
|
Cured |
See below |
|
|
Consider
other causes of fever, may be in association with malaria. |
|
|
P. falciparum |
P. vivax |
|
|
|
Treat as possibly chloroquine resistant |
If the patient has typical malarial complications, treat as P.
falciparum; otherwise, wait. |
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