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| LETTERS TO EDITOR |
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| Year : 2018 | Volume
: 8
| Issue : 2 | Page : 126 |
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Gangrene in malaria revisited
Khichar Purnaram Shubhakaran
Department of Neurology, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| Date of Web Publication | 27-Dec-2018 |
Correspondence Address:
Dr. Khichar Purnaram Shubhakaran
House No. E-22/9, Umaid Hospital Campus, Geeta Bhawan Road, Jodhpur- 342 001, Rajasthan
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/tp.TP_77_15
How to cite this article:
Shubhakaran KP. Gangrene in malaria revisited. Trop Parasitol 2018;8:126 |
Sir,
I read an interesting case report of Plasmodium falciparum malaria complicated by/disseminated intravascular coagulation, severe normocytic normochromic anemia, and symmetrical peripheral gangrene.[1] With the reemergence of malaria, such rare but unique complications of malaria have been observed from time to time and reported mainly from India.[2],[3],[4],[5] A few such cases or complications are also reported in Plasmodium vivax[4] and mixed[5] malaria also. Exact pathogenesis could not be ascertained.[2] Microcirculatory block due to sludging of the parasitized erythrocytes in capillaries is a well-known factor in heavy P. falciparum parasitemia. The blockage of terminal arteries/arterioles could be the important reason for the gangrene. The vascular flow in the organs is disturbed by vascular collapse, thrombosis, infarction, and similar effects brought about by clumping together of parasitized cells. All these factors slow down the circulation and cause “sludging.” In a patient presenting with dry gangrene and fever, a possibility of P. falciparum must be kept in mind, not only in endemic areas but, also in nonendemic areas because of the resurgence of P. falciparum in the last few years.[2]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Rana A, Singh DP, Kaur G, Verma SK, Mahur H. Symmetrical peripheral gangrene: A rare complication of Plasmodium falciparu m malaria. Trop Parasitol 2015;5:130-2.  [ PUBMED] [Full text] |
| 2. | Kochar Shubhakaran DK, Kumawat B, Kochar SK. A patient with falciparum malaria and bilateral gangrene of the feet who developed arrhythmia/ventricular fibrillation after quinine therapy. QJM 1998;91:246. |
| 3. | Arya TV, Singh SP, Singh DK. Bilateral foot gangrene occurring in falciparum malaria. JAPI 1990;38:30. |
| 4. | Arora N, Gogna A, Kumar D, Puri K. Peripheral gangrene in Plasmodium vivax malaria: A rare manifestation. Trop Doct 2013;43:23-4. |
| 5. | Agarwal A, Rastogi A, Tiwari D. Symmetrical peripheral gangrene with mixed malaria. Indian J Pediatr 2007;74:587-8. |
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