P. vivax can cause severe malaria.Haematological morbidity associated with P. vivax infection is greatest in young children, especially in tropical countries where transmission is intense and local parasite strains relapse very frequently (Douglas, 2012). severe anemia and thrombocytopenia that causes bleeding diathesis is produced by hemolysis, reduced cell deformity of parasitized and nonparasitized erythrocytes, increased splenic clearance, reduction of platelet survival, decreased platelet production, and increased splenic uptake of platelets, and can be produced by P. vivax and P. falciparum infection (Luxemburger et al, 1997).

I am pleased to send you this paper about P Vivax.

http://www.malariajournal.com/content/11/1/135

Please see paper by Dr. D.K. Kochar

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294370/pdf/04-0519.pdf

P.vivax can definitely cause severe malaria . Recent studies from Mumbai state that 30% of severe malaria is due to P. vivax . It was assumed that if severe malaria was positive for P. vivax , it must be due to co-infection with P.falciparum . Kochar's studies from Rajasthan have elegantly proved that P. vivax is the cause of severe malaria by PCR studies . In India , P. falciparum occurs in more than 80% in Odisha & surrounding areas , P.falciparum & P. vivax in equal numbers ( 50% ) in Maharashtra & Gujarat & P . vivax in more than 85% in S . India . Even in Chennai , we have been observing severe malaria due to P. vivax . The management of severe P . vivax malaria is similar to P . falciparum .IV. Artesunate or Quinine is the drug of choice for severe malaria.

The pathogenesis of severe malaria is based on the cytokine hypothesis or sequestration hypothesis . Champions of cytokine hypothesis believe that all the complications are due to cytokines similar to sepsis syndrome & sequestration is just a incidental event by P. falciparum to evade the spleen , while proponents of sequestration hypothesis believe that this mechanism plays a vital role . In P . vivax , sequestration does not occur .There is also a view that a subset of virulent P. vivax is responsible for severe malaria . The WHO has recently classified ' severe vivax malaria ' as a distinct entity , accepting that P. vivax can cause severe malaria .

There have been scattered reports in the last years of P. vivax causing cerebral malaria, thrombocytopenia, disseminated intravascular coagulation (DIC), ARDS, and renal failure. However, the diagnosis in these reports is questionable as most of these cases were diagnosed by examination of peripheral blood films, which needs experience, and not confirmed by PCR studies to rule out the co-infections with P. falciparum. This makes some authors to write: “If a patient with P. vivax exhibits severe malaria, the infection is presumed to be mixed”. I am not sure to what extent is this statement true?

I agree with all particularly with Singh. If you are not sure about the literature, I think the best way to be sure is to make your own experience. You can select an area where malaria with P. Vivax is endemic as a site of study.

In fact, I have been involved in a study entitled molecular epidemiology of malaria in Qatar with emphasis on drug resistance. We will identify species on molecular bases at the same time we will study the clinical presentation of different species and their drug susceptibility.

P. Vivax can definately cause severe malaria including multy organ dysfunction.there are a number of publication from different part of world where vivax malaria is endemic.from bikaner,india,we have reported a number cases of severe vivax malaria both in children and adults in which the diagnosis of p.vivax monoinfection was confirmed by pcr. We have also ruled out the possibilities of other diseases by stringent laboratory evaluation.

Yes, but rarely. Plasmodium vivax can cause severe manifestations similar to those of falciparum malaria, with reports of cerebral malaria, renal failure, acute respiratory distress syndrome being reported among vivax-mono-infected patients. However, this remains limited to rare cases and is not a characteristic hallmark as in falciparum malaria.

Kind regards!

Many thanks for all. It is obvious that, vivax malaria is not benign. It can lead to severe malaria, resulting in significant morbidity and mortality. According to WHO, "severe malaria is most commonly caused by infection with Plasmodium falciparum, although P. vivax and P. knowlesi can also cause severe disease".

Yes, but rarely.

recently,there are a number of publication related to retrospective and prospective observational clinical studies from India,Brazil,Papua NG,Indonesia,Pakistan,Sudan and case reports from many countries related to severe vivax malaria.The postmortm confirmation study is also available from India and Brazil.All these have prooved that vivax malaria is definately not a benign disease.

Thanks Dhanpat

I have seen cases of cerebral malaria due to vivax malaria

As Dhapat pointed out, in the past few years there have been increasing reports of severe malaria caused by P vivax. There is a very nice systematic review by Cho Naing (2014) about this. It is very helpful and provides a very good picture of this topic.

Severe Vivax malaria has undoubtedly been recognized as definate entity. All recent monogram of WHO  including those related to malaria elimination has its mention..There is definate description of management. Our recent publication in journal of vector borne disease on severe Vivax malaria has elaborately discussed almost every aspect of this comparatively less discussed condition. We have presented the details of clinical presentation including pattern of multi organ dysfunction and mortality in the largest series of PCR diagnosed cases.We have also compared the phenotype differences between severe Vivax,severe falciparum and severe mixed infection malaria.

Not only from different parts of India but also from Brazil.Pappua new guinea.Indonesia. Pakistan.Bangladesh.few countries of Africa.

yes. reported from different parts of globe

Yes of course. More than 77 reports are published. Very nice systematic reviews are there to present this.

Article Severe vivax malaria: A systematic review and meta-analysis ...

Article Is Plasmodium vivax Malaria a Severe Malaria?: A Systematic ...

Though the WHO criteria for severe malaria are for P.falciparum, the same severe manifestations can occur with P.vivax as well. P.vivax no longer causes "benign" tertian malaria.

There are a no. of good clinical studies from different parts of world using pcr confirmation of p.vivax monoinfection and absence of p.falciparum in cases of severe malaria. Now this is a well described entity.

Four species of Plasmodium are known to cause malaria in humans. ... Severe complications of malaria have been more commonly seen in P. falciparum infections, and those caused by P. vivax have been considered benign.

Severe anemia: P. vivax can cause severe anemia, particularly when it is chronic and recurrent. ... It is more common in vivax malaria than falciparum malaria and tends to occur in up to 0.7% of the patients.

Because of more destruction of normal RBC alongwith parasitized RBC in comparison to falciparum malaria.

The answer to your question is 'yes'. Please take a look at these useful RG links.

Article Is Plasmodium vivax Malaria a Severe Malaria?: A Systematic ...

Article Severe Malaria Associated with Plasmodium falciparum and P. ...

Article The pathophysiology of vivax malaria

Article Complications of vivax malaria in Uttarakhand, India

Article Severe vivax malaria: A systematic review and meta-analysis ...

Article Complicated vivax malaria: A case report from Navi Mumbai

Chapter Severe and Complicated Malaria due to Plasmodium vivax

Severe means what?

If it means acute, life threatening Malaria, P. falciparum is the main culprit.

But if it means recurrent, chronic Malaria, P.vivax is more important.

But

Thanks.

There is enough evidence of severe vivax malaria. There are multiple reports from many countries including Africa. WHO has also accepted and discussed management of severe vivax malaria in WHO annual reports.

https://www.alliedacademies.org/articles/severe-malaria-due-to-plasmodium-vivax-case-report.html

A good effort to study the molecular aspects of severe vivax malaria and its relationship with clinical severity.

Inspite of study on 2 cases,it is worth reading and repeating in more cases

You are right, there is increasing evidence that vivax malaria can cause severe malaria.

Now it also have mention in almost all the WHO publications on p.vivax malaria. Even the book on management of malaria by WHO has a separate section on treatment of severe vivax malaria