A 10-year-old from Bihar presents with fever, rigor, and daily bouts of jaundice. Peripheral blood smear shows infected RBCs enlarged with Schüffner's dots, trophozoites showing amoeboid appearance, and absence of malarial pigment in early stages. Species identified is Plasmodium vivax. The specific danger of P. vivax in this child requiring preventive therapy is:
- A Risk of blackwater fever from haemolysis
- B Hypnozoite-mediated relapse, treated with primaquine after G6PD screening ✓
- C Cerebral malaria from cytoadherence of infected RBCs
- D Chloroquine resistance requiring artemisinin combination therapy
Explanation
P. vivax forms hypnozoites in the liver that can reactivate weeks to months later causing clinical relapse. To prevent relapse, primaquine (radical cure) must be given for 14 days after completing chloroquine treatment. Before prescribing primaquine, G6PD testing is mandatory as primaquine causes severe hemolytic anemia in G6PD-deficient individuals. Blackwater fever (massive hemolysis with hemoglobinuria) is associated with P. falciparum and is rare. Cerebral malaria from cytoadherence is a P. falciparum complication — P. vivax infected RBCs are enlarged and do NOT cytoadhere. P. vivax is generally chloroquine-sensitive in India.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.