Severe Malaria Due to Vivax: The Underestimated Culprit

The World Health Organization's (WHO) Southeast Asia Region bears a significant burden of Plasmodium vivax (P. vivax) malaria, accounting for approximately 53% of the global total. Notably, India alone accounted for 47% of this burden in 2018. Historically, P. vivax has been regarded as a relatively benign species, typically causing mild, uncomplicated and self-limiting disease. Plasmodium vivax is known to cause relapsing malaria, but rarely causes severe malaria with cerebral involvement. Only a few cases of cerebral malaria due to P. vivax monoinfection have been reported in the literature. The parasite's preference for attacking reticulocytes in the blood results in lower parasitemia levels, making it potentially undetectable in blood smears and requiring high-level microscopic expertise for accurate diagnosis. It is essential to identify P. vivax infections accurately, as the treatment approach differs due to the higher relapse rate compared to P. falciparum infections. We report a rare case of cerebral malaria caused by mono-infection with Plasmodium vivax in a patient originally from northern India, now residing in rural Bangalore.