Times of India
06 July 2010
Mumbai, India

Malaria version mutates into killer
When two patients with paralysis were recently wheeled into the emergency room at KEM, they could not have imagined that malaria was behind their condition. A series of tests established that it was falciparum malaria that had caused paralysis in their limbs.

“As KEM is a referral hospital, we are used to getting the most unusual of cases,” said head of medical intensive care unit Dr Nitin Karnik, who treated both patients. Specific treatment resulted in the patients regaining almost 60% of their movement, said Dr Karnik, adding that this has been a peculiar year for malaria.

Last year, about 36% of malaria cases and 67% of malaria deaths in Maharashtra occurred in Mumbai.Worse,said Dr Karnik, the usually benign version of malaria called vivax has metamorphosed into a virulent killer. “In the last six to 12 months, there have been cases with complications that we have never seen before,” he added.

Mumbai: The mutation of a version of malaria called vivax in the last few years is worrying doctors. Low platelet count, which was thought of as the hallmark of falciparum malaria, is now common in patients with vivax malaria as well. Said infectious diseases specialist Dr George Oomen, “Until a few years ago, a patient with the vivax strain of malaria was administered a course of chloroquine and asked to go home to rest. But now he could end up in the intensive care of a hospital.”

According to Dr Khusrav Bajan, head of intensive care in Hinduja Hospital, Mahim, “Until five years back, a malaria patient would not have cold and cough. Now, such double infections are common. Secondly, the danger signs associated with falciparum malaria–multi–organ failure or acute respiratory distress syndrome–are now seen with vivax as well. “A vivax attack could leave patients with massive and permanent lung injury,” added Dr Bajan.

A year back, the Indian Journal of Critical Care Medicine carried a report from Yashoda Hospital in Hyderabad about a 42–year–old patient reporting with ARDS. “Plasmodium vivax malaria seldom resulting in pulmonary damage, and pulmonary complications are exceedingly rare, wrote the authors Dr Prasad Kasliwal, Dr Manimala S Rao and Dr Rash Kujur.

So what has brought about this change in malarial patterns? Dr Karnik suspected genetic mutation had made the parasite more virulent. “Climatic change could be one of the reasons,” said Dr Bajan.

A paper published in February 2010 in the Quarterly Review of Biology, however, presents an all–round picture: “Climate change is one reason malaria is on the rise in some parts of the world. But according to new research, other factors such as migration and land–use changes are likely to also be at play.” The paper review the rising incidence of malaria in South Asia and Africa.

A major future challenge will be to link up what happens with mosquitoes and parasites at the household level with long–term climate change scenarios at the continental scale, the authors added.