The clinical and radiologic characteristics of non cardiogenic pulmonary edema of vivax malaria

초록

The pulmonary manifestations by P. vivax infection are reported from non productive cough to ARDS. But the overall manifestations of pulmonary involvement of P. vivax have not been well known. Recently we have experienced increasing cases of P. vivax infection accompanied with respiratory symptoms. We have analyzed clinical characteristics and radiologic findings of pulmonary manifestations of P. vivax in Korea where malaria has reemerged since mid-1990s. From January 2006 to December 2007, P. vivax patients who have visited the Inha university hospital, Incheon, Korea, were enrolled. Clinical manifestations and laboratory results were analyzed and HRCT were undergone in patients with chest X-ray abnormalities. Of 125 P. vivax patients, 105 (85.0%, 105/125) patients underwent radiologic examinations (simple chest X-ray or HRCT). 38 patients (36.2%, 38/105) revealed respiratory symptoms or radiologic abnormalities related to malaria infection. Among 28 patients (26.7%, 28/105) with radiologic abnormalities, 18 patients (64.2%, 18/28) showed those findings before antimalarial treatment. The elderly (>60 years old), female sex, initial high parasite burden (>4,000/uL) and thrombocytopenia (< 50,000/uL) were associated with radiologic abnormalities (respectively, p=0.06, 0.059, 0.014, 0.0096), and in multivariate analysis, initial high parasite burden and thrombocytopenia were statistically significant (respectively, p=0.094, 0.037). All patients were recovered without any sequealae. HRCT were taken among 12 patients with abnormal chest Xray. Interlobular septal thickening (100%, 12/12), pleural effusion (66.7%, 8/12) and ground glass opacity (25%, 3/12) were the most common HRCT findings. The result suggests that P. vivax infection could be complicated with radiologic abnormalities so frequently. The further studies on the epidemiology and mechanisms of pulmonary involvements of P. vivax should be followed.