Journal of the Pancreas Open Access

Keywords

Pancreatitis; Plasmodium falciparum; Plasmodium vivax; Polymerase Chain Reaction

Dear Sir,

We thank Padukone et al. for their interest in our case report [1, 2]. We agree that ideally polymerase chain reaction (PCR) should be done to conclusively prove that a given individual has mono-infection with Plasmodium vivax. While the traditional smear and the rapid diagnostic tests can help diagnose the species responsible in majority of cases, low parasitemia is their Achille’s heel. Also these tests have high specificity [3]. But the availability of the PCR remains only in research settings and their clinical use has not yet become routine. Elegant studies based on PCR detection have conclusively proven that vivax can cause severe manifestations of malaria [4]. To conclude, our patient definitely had Plasmodium vivax infection and evidence of acute pancreatitis. In absence of availability of PCR and in wake of recent conclusive evidence of severe manifestations occurring related to Plasmodium vivax, it is reasonable to conclude that vivax infection might have been the cause of acute pancreatitis in our patient. Also, we feel that the need to obtain PCR before blaming vivax for severe malaria arises due to the traditional belief that Plasmodium vivax causes ‘benign’ malaria [5]. With clear evidence to the contrary, it is time that clinicians and researchers consider Plasmodium vivax as a possible cause of severe malaria.

Conflict of interest

The authors have no potential conflict of interest

References

1. Padukone S, Veerabhadraiah SR, Achur R. Need for PCRAnalysis in Assessing Severe Malaria Infections with Plasmodiumvivax. JOP 2012; 13(3):322.
2. Sharma V, Sharma A, Aggarwal A, Bhardwaj G, Aggarwal SAcute Pancreatitis in a Patient with vivax Malaria. JOP. J Pancreas(Online) 2012 46 Mar 10; 13(2):215-216.
3. Ndao M, Bandyayera E, Kokoskin E, Gyorkos TW, MacLeanJD, Ward BJ. Comparison of blood smear, antigen detection, andnested-PCR methods for screening refugees from regions wheremalaria is endemic after a malaria outbreak in Quebec, Canada.JClinMicrobiol. 2004 Jun;42(6):2694-700.
4. Tanwar GS, Khatri PC, Sengar GS, Kochar A, Kochar SK,Middha S, TanwarG,Khatri N, Pakalapati D, Garg S, Das A, KocharDK. Clinical profiles of 13children with Plasmodium vivax cerebralmalaria. Ann Trop Paediatr 2011;31(4):351-6.
5. Gogia A, Kakar A, Byotra SP. Is benign tertian malaria actuallybenign? TropDoct. 2012 Apr;42(2):92-3.