English

Abstract

BACKGROUND AND OBJECTIVE: Malaria, a disease with protean manifestations is endemic in India with an estimated 70-100 million cases each year. Of these 45-50% are plasmodium falciparum. The present study is aimed at to study clinical features, complications, response to treatment and outcome in a tertiary care hospital. METHODOLOGY: This hospital based prospective study was done on 100 confirmed cases of falciparum malaria (either by peripheral smear or rapid diagnostic test) admitted in Department of Medicine, G.R. Medical College, Gwalior (M.P) from July 2013 to November 2014.A case sheet proforma was prepared and data (demographic profile, clinical feature, investigation, treatment, and complication) from all indoor patients was collected and analyzed. RESULT: Out of 100 patients, 65(65%) were males and 35 (35%) were females. Most of the patients were between the age group 21-40 years. The numbers of admissions due to malaria increased from July onward with maximum number of cases were found in the month of August. Fever was the most common symptom followed by headache, nausea and vomiting. Anemia was present in 50(50%) patients followed by hepatomegaly (32%) and spleenomegaly (30%). Jaundice was seen in 47% cases in this study while significant jaundice was seen in 19% case out of which 4% cases was predominantly unconjugated jaundice and 15% cases was predominantly conjugated jaundice. In this study 9% cases found to have malarial hepatopathy. Prothombin time is usually normal and significant prolongation seen in 15% cases. Severe hypoalbuminemia (<2 gm%) was seen in 5% cases out of which 1% case was presented with very high level of bilirubin. Incidence of renal dysfunction was 18% out of which 14% patients associated with significant rise in serum bilirubin. In patients of significant jaundice duration of hospital stay was prolonged. Mortality was seen in 2% cases, 1% presented with significant hepatocellular jaundice and another 1% presented with significant cholestatic jaundice. These 2% cases had also associated with renal dysfunction. CONCLUSION: Liver is commonly involved in falciparum malaria and ranges from mild elevation in serum bilirubin and liver enzymes to elevation above significant level. Jaundice is a serious complication in falciparum malaria. Prognosis of these patients is poor.