AST/ALT Ratio In Acute, Uncomplicated Falciparum Malaria Infection: Comparison In Relation To The AST/ALT Ratios In Diseases Of The Liver

Abstract

Introduction: Serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities were assayed in 110 adult patients (age range 18-40 years) presenting with acute, uncomplicated falciparum malaria infection and a control group of 80 age and sex-matched adults. Methods: Patient selection was done by simple random sampling of adult males and females presenting at the Bauchi State Specialist Hospital with a history of fever and malaise not lasting more that seven days and who were subsequently confirmed to be malaria-positive by microscopic examination of Giemsa-stained thin blood slides. Results: The mean serum AST and ALT activities were found to increase significantly relative to the AST and ALT values in the control group. Serum AST activity was 38.29 ± 1.37 IU in the falciparum malaria patients and 30.19 ± 1.37 IU in the healthy controls, p < 0.05. Similarly serum ALT activity was 31.06 ± 0.58 IU in falciparum malaria patients and 24.96 ± 0.92 IU in the control group, p < 0.05. The mean AST/ALT ratio in acute falciparum malaria infection was found to be 1.22 ± 0.14. This ratio differs significantly from the AST/ALT ratios reported for patients with Non-alcoholic steatohepatitis, chronic hepatitis C, alcoholic liver disease, hepatitis B and cirrhosis, p < 0.05. Conclusion:An AST/ALT ratio greater than 1 during acute falciparum infection contradicts earlier reports that the ratio is highly specific to cirrhosis alone or has application as marker of liver disease only. Therefore the application the AST/ALT ratio as a non-invasive means of assessing liver disease must be done with caution in the tropics where P. falciparum malaria infection is among the leading causes of hospital attendance.