JOP. Journal of the Pancreas

JOP. J Pancreas (Online) 2012 May 10; 13(3):323.

PCR, Antigen Detection and Peripheral Smear for Diagnosis of Malaria

Vishal Sharma¹, Sourabh Aggarwal²

¹Department of Gastroenterology, Postgraduate Institute of Medical Education and Resarch, Chandigarh, India. ²Department of Medicine, University College of Medical Sciences. Delhi, India

Dear Sir,

We thank Padukone et al. for their interest in our case report [1, 2]. We agree that ideally polymerase chain reaction (PCR) should be done to conclusively prove that a given individual has mono-infection with Plasmodium vivax. While the traditional smear and the rapid diagnostic tests can help diagnose the species responsible in majority of cases, low parasitemia is their Achille’s heel. Also these tests have high specificity [3]. But the availability of the PCR remains only in research settings and their clinical use has not yet become routine. Elegant studies based on PCR detection have conclusively proven that vivax can cause severe manifestations of malaria [4]. To conclude, our patient definitely had Plasmodium vivax infection and evidence of acute pancreatitis. In absence of availability of PCR and in wake of recent conclusive evidence of severe manifestations occurring related to Plasmodium vivax, it is reasonable to conclude that vivax infection might have been the cause of acute pancreatitis in our patient. Also, we feel that the need to obtain PCR before blaming vivax for severe malaria arises due to the traditional belief that Plasmodium vivax causes ‘benign’ malaria [5]. With clear evidence to the contrary, it is time that clinicians and researchers consider Plasmodium vivax as a possible cause of severe malaria.

Received April 21^st, 2011

Key words Pancreatitis; Plasmodium falciparum; Plasmodium vivax; Polymerase Chain Reaction

Conflict of interest The authors have no potential conflict of interest

Correspondence
Vishal Sharma
Department of Gastroenterology
Postgraduate Institute of Medical Education and Research

Chandigarh 160012
India
Phone: +91-950.101.3399
Fax: +91-112.259.5974
E-mail: docvishalsharma@gmail.com

References

1.  Padukone S, Veerabhadraiah SR, Achur R. Need for PCR Analysis in Assessing Severe Malaria Infections with Plasmodium vivax. JOP 2012; 13(3):322.

2.  Sharma V, Sharma A, Aggarwal A, Bhardwaj G, Aggarwal S Acute Pancreatitis in a Patient with vivax Malaria. JOP. J Pancreas (Online) 2012 46 Mar 10; 13(2):215-216. PMID:22406604

3.  Ndao M, Bandyayera E, Kokoskin E, Gyorkos TW, MacLean JD, Ward BJ. Comparison of blood smear, antigen detection, and nested-PCR methods for screening refugees from regions where malaria is endemic after a malaria outbreak in Quebec, Canada.J Clin Microbiol. 2004 Jun;42(6):2694-700. PMID: 15184454

4.  Tanwar GS, Khatri PC, Sengar GS, Kochar A, Kochar SK, Middha S, Tanwar G,Khatri N, Pakalapati D, Garg S, Das A, Kochar DK. Clinical profiles of 13children with Plasmodium vivax cerebral malaria. Ann Trop Paediatr 2011;31(4):351-6. PMID: 22041470.

5.  Gogia A, Kakar A, Byotra SP. Is benign tertian malaria actually benign? TropDoct. 2012 Apr;42(2):92-3. PMID: 22431827