9th International Conference on Plasmodium vivax Research (ICPvR) – 2025: Pre-conference Workshop

MESA Correspondents bring you cutting-edge coverage from the ICPvR 2025 “Plasmodium vivax: Science and tools for elimination” and the Pre-conference Workshops on Severe Vivax Malaria: Diagnosis and Management for Clinicians.

Pre-conference Workshop – Severe Vivax Malaria: Diagnosis and Management for Clinicians

Workshop 1 – The pathophysiology of severe vivax malaria

Nicholas Anstey (Menzies School of Health Research, Australia) discussed the worldwide impact of Plasmodium vivax malaria, which is mostly reported in India and Indonesia. He emphasized its chronic nature, frequent relapses, and potential for serious illness. A key focus was the hidden parasite biomass in the spleen, constituting 98% of the total parasite burden in chronic infections and 88% in acute cases. Anstey discussed that P. vivax-infected red blood cells (RBCs) accumulate in small blood vessels, while uninfected RBCs lose deformability, resulting in endothelial activation, thrombotic microangiopathy, and impaired circulation. Rosette formation complicates anemia by causing uninfected RBC loss by splenic trapping and relapses. Organ-specific complications can involve splenic rupture, more prevalent in adults and occurring more commonly with P. vivax than P. falciparum, with thrombocytopenia, which raises the risk of severe illness in both adults and children. Other organ-specific complications, such as acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI), show geographical patterns, with over 75% of AKI cases reported from India. Anstey concluded the talk by highlighting that pregnant women have an elevated risk of severe P. vivax malaria, with studies indicating higher risks among women in Brazil, India, and the Thai-Myanmar border area.

Workshop 2 – Multi-organ dysfunction in vivax malaria and the comparison of the phenotype with severe falciparum malaria and mixed infection malaria

Dhanpat Kochar (Sardar Patel Medical College, India) highlighted the increasing incidence of severe malaria observed in Plasmodium vivax infection. Kocher discussed the differentiation between sequestration and non-sequestration forms of severe malaria. The presentation included case reports, with P. vivax mono-infection who presented with high-grade fever, jaundice, renal failure, severe anemia, and thrombocytopenia. Another case involved a pregnant woman with anemia and more reports include pulmonary edema/ARDS, and hypoglycemia, leading to coma and severe dysfunction. Kochar highlighted a case of post-malaria neurological syndrome (PMNS) in a patient who developed bilateral facial palsy on the 14th day of recovery. Kochar also discussed research findings indicating that cerebral involvement, though rare in P. vivax malaria, can lead to life-threatening complications. He emphasized that P. vivax malaria frequently presents with thrombocytopenia, though no clear correlation exists between parasite density and platelet count. He noted that infections during pregnancy contribute to maternal anemia, preterm birth, fetal loss, and low birth weight. The key takeaway from Kochar’s talk was that submicroscopic infections in pregnancy often go undiagnosed, leading to untreated placental malaria, which significantly increases the risk of fetal and maternal mortality.

Workshop 3 – Management of severe vivax malaria

Kavitha Saravu (Kasturba Medical College, India) emphasized the World Health Organization (WHO) definitions of severe Plasmodium vivax malaria based on various clinical and laboratory features. These criteria include impaired consciousness, prostration, multiple convulsions, pulmonary edema, acute respiratory distress syndrome, acute kidney injury, abnormal bleeding, hypoglycemia, metabolic acidosis, hyperparasitemia, renal impairment, and pulmonary edema. Saravu’s interactive approach, combined with real-life case discussions, effectively highlighted the complexities of clinical management, including the challenges presented by recurrent malaria. Saravu presented a case in which a patient experienced multiple recurrences of malaria within eight months.  Additionally, Saravu pointed out common pitfalls in the management of P. vivax malaria, such as: presumptive treatment without proper diagnosis, misidentification of infecting species or gametocytes as active infections, misclassification of severe P. vivax infections, failure to provide radical cure with primaquine and G6PD testing, assuming all treatment failure cases are due to resistant malaria, and presuming all recurrent cases of malaria are resistant or complicated. Her insights into these challenges are critical for improving the management and treatment outcomes for patients with severe P. vivax malaria.

Workshop 4 – Clinical outcomes and long-term consequences of severe malaria

Sanjay Kochar (Sardar Patel Medical College, India) discussed the complications of severe Plasmodium vivax malaria, including anemia, kidney and lung injury, jaundice, cerebral malaria, post-malarial neurological syndrome, bleeding, shock, and splenic rupture. Kochar also highlighted that patients post-splenectomy, are at increased risk of severe malaria, recurrent relapses, infections, and hemolysis, necessitating constant monitoring and preventive strategies such as prophylaxis and vaccinations. Long-term consequences were addressed, such as congenital and neurodevelopmental disabilities, cardiac complications, chronic kidney disease (CKD), post-malarial syndrome, hepatic dysfunction, chronic liver disease, persistent inflammatory response and autoimmune disorders, metabolic dysregulation and increased risk of diabetes, neurological complications, maternal anemia, premature labor and low birth weight, fetal loss, fatal respiratory complications, and relapsing malaria. To illustrate post-malarial syndrome, he presented a P. vivax case of renal failure requiring hospitalization and hemodialysis, which later led to chronic fatigue, joint pain, cognitive issues, and sleep disturbances. Kochar concluded by stating that severe malaria has a major socio-economic impact beyond health, particularly affecting vulnerable populations, and cited a case of a patient who struggled with hospitalization expenses.

Workshop 5 – Diagnostic modalities in vivax malaria

Vishnu Teja Nallapati (Kasturba Medical College, India) addressed the challenges of diagnosing Plasmodium vivax malaria and discussed current diagnostic approaches, highlighting their advantages and disadvantages. Nallapati presented various methods, including microscopy, quantitative buffy coat (QBC), and rapid diagnostic tests (RDTs). Molecular diagnostic techniques such as nested polymerase chain reaction (PCR), quantitative PCR (qPCR), Loop-Mediated Isothermal Amplification (LAMP), and the mini dot blood nucleic acid lateral flow immunoassay were also discussed. Additionally, he emphasized the potential of using serological surveillance methods such as enzyme-linked immunosorbent assay and immunofluorescent assay (IFA) to identify individuals exposed to P. vivax. The presentation was followed by a microscopic demonstration of the ring form, schizont, and gametocyte stages of P. vivax, along with hands-on experience in conducting an RDT. This combination of theoretical insights and practical demonstrations made the information more tangible and beneficial for the audience.