Presented byMC. Pochong UthaitasMC. Wuttipat Pusanasuwannasri3rd years medical cadet Phramongkutklao college of medicine 11

BackgroundBackground

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Increasing in mortality rate of severe vivax malaria

ObjectivesObjectives

• To describe the geographical variation in prevalence of severe vivax malaria

• To describe the different presenting syndromes and characteristics

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MethodsMethods

Systematic reviews and meta analysis

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MethodsMethods

Search term and search strategySearch term and search strategy

Patients: (1) Plasmodium vivax, (2) Severe OR complicated, (3) 1 AND 2.Outcomes: (4) Cerebral complication, (5) Convulsions, (6) Kidney injury, (7) Renal failure, (8) Hemoglobinuria, (9) Circulatory collapse, (10) Shock, (11) Jaundice, (12) Hyperbilirubinemia, (13) Hepatic dysfunction, (14) Bleeding, (15) Hemorrhage, (16) Thrombocytopenia, (17) Disseminated intravascular coagulation, (18) DIC, (19) Acute respiratory distress syndrome, (20) ARDS, (21) Pulmonary edema, (22) Metabolic acidosis, (23) Hyperlactatemia, (24) Severe anemia, (25) Hypoglycemia, (26) Death

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MethodsMethods

Selection criteriaSelection criteria

Inclusion criteria

•Thrombocytopenia and severe falciparum criteria

Exclusion criteria •Duplicate reporting

• Mixed infections

• Insufficient data

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MethodsMethods

Bias assessment and quality assureranceBias assessment and quality assurerance

• Eligibility for inclusion of every article was reviewed by independent reviewers

• Disagreements between reviews were validated by an independent person

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Statistical analysisStatistical analysis

Software STATA version 12 was used for statistical analysisSoftware STATA version 12 was used for statistical analysis

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ResultsResults

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ResultsResults

77 studies with severe vivax77 studies with severe vivax

Geographical origin : from 77 studies42 (54.5%) South-east Asia17 (22.1%) Americas10 (13.0%) Eastern-Mediterranean8 (10.4%) Western pacific

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Results for 1st objectiveResults for 1st objective

Results for 2nd objectiveResults for 2nd objective

• To describe the geographical variation in prevalence of severe vivax malaria

• To describe the different presenting syndromes and characteristics

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ResultsResults

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Severe Thrombocytopenia 52528 888 4.7 2.3-7.0

ResultsResults

Severe Thrombocytopenia 45775 888 8.6 5.4-11.8

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ResultsResults

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Severe vivax malaria- increase large number in non-endermic area;

India

- In patient with vivax malaria mortality rate was 28.2%

Most prevalent severity sign reported was thrombocytopenia(26.1%)

DiscussionDiscussion

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One contributor to this discrepancy is the inclusion of thrombocytopenia as a severity criterion in recent series One contributor to this discrepancy is the inclusion of thrombocytopenia as a severity criterion in recent series

Prevalence of severe vivax in IndiaPrevalence of severe vivax in India

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Unclear description of Chloroquine resistance except in the island of new Guinea, Indonesia Papua and Amazonas

DiscussionDiscussion

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DiscussionDiscussionMisdiagnosis caused by other febrile illness and co-infection

Non endemic areaEndemic area202

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Change in strain virulence

DiscussionDiscussion

Increase in reported cases

No hard data available to support this hypothesis

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ConclusionConclusion

Increase in reported case of severe vivax in certain geographical regionIncrease in reported case of severe vivax in certain geographical region

Cannot be explained with the current knowledgeCannot be explained with the current knowledge

The use of thrombocytopenia as an independent severity criterion required justification

The use of thrombocytopenia as an independent severity criterion required justification

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TitleSystematic review and meta-analysis

AbstractProvide structured summary

Introduction Clear objectives

Critical appraisalCritical appraisal

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MethodsSearch strategySearch termEligibility criteria Information sourceBias assessment

Critical appraisalCritical appraisal

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ResultsPrecise Reasonable

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