Uncomplicated Plasmodium vivax malaria in pregnancy associated with mortality from acute respiratory distress syndrome
Open accessAbstract
The association between severe malaria and Plasmodium vivax species is contentious. On the Thai-Myanmar border, all pregnant women are followed systematically with active weekly malaria screening. Over a 27-year period of providing antenatal care, 48,983 have been prospectively followed until pregnancy outcome (miscarriage or delivery) and 4,298 women have had P. vivax detected at least once. Reported here is the first known P. vivax-associated death amongst these women. The initial patient presentation was of uncomplicated P. vivax (0.5% parasitaemia) in a term, multigravida woman who responded rapidly to oral artesunate and mefloquine treatment, clearing her blood stage parasites within 48 hours. The patient appeared well, was ambulatory and due to be discharged but became unwell with acute respiratory distress syndrome (ARDS) requiring ventilation three days (67 hours) into treatment. Despite induction and delivery of a stillborn foetus, ventilatory requirements increased and the patient died on day 7. The patient had a low body mass index. Sensitive detection with nested PCR confirmed only the presence of P. vivax species and concomitant infections such as tuberculosis and human immunodeficiency virus (HIV) were also ruled out. The contemporaneous treatment of acute uncomplicated P. vivax and the onset of ARDS on day 3 in this patient implies a possible but unconfirmed association with death in this patient. Assuming this death was caused by P. vivax, the risk of ARDS-related maternal mortality in this setting did not differ significantly between Plasmodium falciparum and P. vivax (0.24 per 1,000 (1/4,158) versus 0.23 per 1,000 (1/4,298), contrary to the increased risk of maternal mortality from P. falciparum compared to P. vivax, 2.89 per 1,000 (12/4,158) versus 0.23 per 1,000 (1/4,298), P = 0.003.
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P.vivax infection during pregnancy can also cause severe pre-eclampsia and trigger acute respiratory distress syndrome (ARDS).
“Additionally, studies have shown that P.vivax infection during pregnancy can also cause severe pre-eclampsia and trigger acute respiratory distress syndrome (ARDS) [90, 91].”
From Current update on malaria in pregnancy: a systematic review (2025) · cites this paper as [91]
The Background and Conclusion (pages unavailable) describe ARDS developing in a pregnant patient treated for P. vivax, but the Conclusion says its relationship to the infection cannot be proven. Our copy does not report severe pre-eclampsia, and the claim’s causal wording is stronger than the paper supports. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMaternal anemia and infections can impair the supply of oxygen and nutrients to the fetus, contributing to outcomes like intrauterine growth restriction and preterm delivery.
“Maternal anemia and infections can impair the supply of oxygen and nutrients to the fetus [89], contributing to outcomes like intrauterine growth restriction and preterm delivery [90, 91].”
From Current update on malaria in pregnancy: a systematic review (2025) · cites this paper as [91]
Citation [89] is attached to the claim about impaired oxygen and nutrient supply to the fetus; the later outcomes are cited to [90, 91]. The Background discusses impaired gas transfer in malaria patients, and the Case presentation and Conclusion describe a pregnant patient with anaemia and malaria, but no passage connects either condition to reduced fetal oxygen or nutrient supply. Searches for fetal oxygen, nutrients, and placental supply found no such passage. (LLM, conf=0.76)
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Self-citation
- Authors
- McGready, R., Wongsaen, K., Chu, C. S., Tun, N. W., Chotivanich, K., White, N. J., & Nosten, F.
- Affiliations
- Mahidol University (TH)
- Corresponding author
- McGready, Rose
- Venue
- Malaria Journal
- Published
- 2014-05-27
- Volume
- 13
- Issue
- 1
- Pages
- 191-191
- ISSN
- 1475-2875 (ISSN-L)
- PMC
- PMC4046059
- OpenAlex
- W2129647777
- Cited by
- 27
- References
- 16
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 4 · 2022: 1 · 2021: 3 · 2019: 1 · 2018: 1 · 2017: 3 · 2016: 2 · 2015: 7 · 2014: 2
- FWCI
- 4.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Malaria Journal (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Greater South Information System
- Funders
- Wellcome Trust (093956, 093956/Z/10/Z)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Genetics › Hemoglobinopathies and Related Disorders
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- Plasmodium vivax, malaria in pregnancy, acute respiratory distress syndrome, maternal mortality, uncomplicated malaria, Plasmodium falciparum, artesunate, mefloquine, stillbirth, Thai-Myanmar border, low body mass index
- MeSH terms
- Artesunate, Adult, Antimalarials, Myanmar, Female, Humans, Pregnancy, Pregnancy Complications, Infectious, Respiratory Distress Syndrome, Thailand, Mefloquine, Malaria, Vivax, Fatal Outcome, Artemisinins, Stillbirth
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