Despite the increasing evidence of CQ-resistance worldwide, the Brazilian Ministry of Health still recommends CQ as the first line therapy for vivax treatment, considering that only one single study has properly shown~10% of resistance in the area of Manaus [172] . The few available efficacy studies on ACT for the treatment of vivax were reviewed recently [175] , and give good evidence for their use in vivax malaria, however, more studies are needed. Only recently the Brazilian Ministry of Health followed the WHO recommendations to manage vivax severe patients with parenteral artemisinin derivatives as if they had severe falciparum infection, considering that a submicroscopic mixed infection could be misdiagnosed in the routine TBS [106] . This recommendation was already stated by the famous Brazilian parasitologist Samuel Pessôa in his Medical Parasitology textbook, from 1967 [176] . Supportive therapy is even more neglected and there is virtually no study focusing in the clinical management of patients with severe vivax disease.