## Epidemiology of Malaria in India **Key Point:** Plasmodium vivax is the most common cause of malaria in India, accounting for approximately 50–60% of all malaria cases, followed by P. falciparum (30–40%). ### Geographic Distribution P. vivax predominates in: - Northern India (Himalayan foothills) - Central India - Parts of the Northeast - Rural and semi-rural areas P. falciparum is more common in: - Coastal regions - Forest areas of Odisha and Chhattisgarh - Southern India ### Morphological Features on Blood Smear | Feature | P. vivax | P. falciparum | P. malariae | |---------|----------|---------------|-------------| | **RBC size** | Enlarged | Normal to slightly enlarged | Normal | | **Stippling** | Schüffner's (coarse) | Maurer's clefts (fine) | Maurer's dots | | **Ring forms** | Large, irregular | Small, delicate, multiple | Small | | **Parasite count** | Up to 10,000/μL | Up to 100,000+/μL | Up to 20,000/μL | **High-Yield:** Schüffner's stippling is pathognomonic for P. vivax and P. ovale on light microscopy. ### Clinical Significance **Clinical Pearl:** P. vivax causes: - Tertian fever (fever every 48 hours) - Milder disease than P. falciparum - Relapsing malaria due to hypnozoites in the liver - Lower parasitemia (<1% RBCs) **Warning:** Although P. vivax causes milder acute disease, it has a higher relapse rate and can cause severe malaria in pregnancy and in patients with G6PD deficiency. [cite:Park 26e Ch 9]
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