Ocular manifestations in vivax disease apparently have no relation to cerebral malaria or bad prognosis, as is the case for falciparum [141] . Few reports have been published on vivax patients with non-severe disease and retinal haemorrhage [142] and in Brazil this fundoscopical finding was associated with hypovitaminosis A [35] . Another atypical complication, which may be more frequent than expected for vivax infection, and with outstanding impact upon the development of some emerging economies in the globe, is poor school performance which should be a surrogate marker for the intellectual impairment related to malaria [143] . Acute malnutrition has been shown to be a complication of vivax malaria in highly endemic areas [144] . In Brazil a few evidences show that malnourishment and vivax co-exist but the impact of this association is still unknown [145] . In only two studies was malnutrition referred to as a possible cause of the reported clinical complication [92, 146] . Vasculitis [66] , leukemoid reaction [76] and pleural effusion [62] as a marker of severity seems to be speculative and details of these reports do not support any in-depth analysis.