Need for PCR analysis in assessing severe malaria infections with Plasmodium vivax.

Even though Plasmodium vivax is highly prevalent in India, the studies are limited not only due to its benign nature but also because of the magnitude of severity caused by P. falciparum malaria. In a recent interesting case report published in this journal it has been reported that this is the first reported case of vivax malaria associated with acute pancreatitis, which resulted in mortality [1]. In this case report, the diagnosis has been made on the basis of traditional smear microscopy and malaria rapid diagnostic test. However, we consider that, the patients’ blood could have been subjected to polymerase chain reaction (PCR) analysis to confirm the P. vivax mono-infection. The 18S rRNA PCR diagnostics has been employed in some of the severe vivax malaria case studies reported from India, which is particularly important to evaluate the actual burden of vivax malaria [2, 3, 4]. In a recent observational and prospective PCR-based study conducted at a tertiary care hospital in Northwestern India, the involvement of P. vivax mono-infection has clearly been proven unequivocally among thirteen children with cerebral malaria and multi-organ dysfunction [5]. Similarly, there is an urgent need for multi-centric and prospective studies by using PCR detections of severely ill malaria patients along with traditional detection methods to assess the genuine burden of severe and fatal disease associated with vivax malaria.