Kolkata: Now, feverless malaria cases set off mutating parasite fears – Times of India

Kolkata News
KOLKATA: A few cases of malaria without fever have been reported from at least two private hospitals in Kolkata, which, doctors say, is rare and surprising since these patients have other symptoms that are very severe. While one of the malaria patients at a hospital had jaundice without fever, another suffered kidney failure and needed ventilation and yet another had Covid along with malaria but no temperature.
All these patients tested positive for plasmodium vivax, the malarial parasite that rarely attacks the kidney or the lungs. Some experts believe this could be the result of a mutation of the parasite that could now be targeting newer organs.
While plasmodium falciparum malaria affects the liver, kidney, brain and lungs and the vivax variety mostly affects hematopoietic (blood) system, liver and spleen.
When a 35-year-old sought admission at a city hospital last week with ‘palsmodium vivax’ malaria, doctors were stunned to find he had no temperature or even history of fever over the last seven days. His symptoms were primarily severe body ache and weakness. Two other patients with ‘full-blown cerebral malaria’ suffered no rigor — the most common symptom of malaria — and had very mild intermittent fever. Yet another patient got admitted with cough, breathing distress and thigh pain — symptoms that are rarely associated with malaria. “None of these patients had rigor or high fever which are the first indicators of malaria. Rather, the symptoms were unusual but very severe,” said Belle Vue internal medicine consultant Rahul Jain.

‘No-fever malaria can signify weak immune system’
Belle Vue internal medicine consultant Rahul Jain said: “Two of the four malaria patients we treated had very mild fever that couldn’t be recorded and the other two had no fever despite one having tested positive for Covid. Yet, two had kidney failure and jaundice and one had to be put on ventilation, though he has now come out of it.”
This phenomenon is termed “rare presentation of a common disease”, where the traditional symptoms are overshadowed by unusual or new ones, said RN Tagore International Institute of Cardiac Sciences (RTIICS) intensivist Sauren Panja. “In rare cases, malaria patients have multiple severe symptoms that overshadow fever. In some of these cases, due to the severity of other symptoms, the patients fail to notice or feel mild temperature. We have come across two-three such patents over the last few weeks at RTIICS,” said Panja.
Usually the young and the very old suffer from unusual malarial symptoms, Panja said.. “Often, the elderly fail to notice the rigor. The younger patients, on the other hand, tend to feel lethargic but don’t suffer from fever or rigor,” he said, adding that interchanging symptoms of falciparum and vivax were worrying. “This could mislead treatment in the initial stages as doctors won’t be prepared to protect organs like the kidney or lungs in a vivax patient,” he said.
According to CMRI Hospital’s director of pulmonology Raja Dhar, absence of fever in malaria patients could even signify a weak immune system. “Body temperature is the result of an immune response to an infection. It could be weak due to co-morbidities, leading to no fever even in case of malaria. But that would also mean that the malarial attack would be severe in the absence of a strong immune response with chances of severe co-morbidities, which is probably happening,” he added.

Source: https://timesofindia.indiatimes.com/city/kolkata/kolkata-now-feverless-malaria-cases-set-off-mutating-parasite-fears/articleshow/85675602.cms