Severe Falciparum malaria in Samarinda, Indonesia

Abstract

Background: Severe malaria remains a major health problem in Eastern part of Indonesia, although nationally malaria cases are decreasing. Delay in recognizing severe malaria cases and lack of knowledge and facilities contribute to high mortality rate of severe malaria. The aim of this study was to evaluate the clinical apprearances and laboratory findings of severe falciparum malaria patients in Samarinda. Methods & Materials: This study was performed at Abdul Wahab Sjahranie General Hospital, Samarinda, East Kalimantan, Indonesia from August 2011 to October 2013. Subjects were adult severe falciparum malaria patients. Antimalarial given were quinine infusion 10 mg/kg BW/8 hour for at least 48 hours, continued with oral antimalarial artemether-lumefantrine 4 tablets every 12 hour for 3 days when patients’ conditions improved. Results: There were 21 patients observed during this study, consisting of 17 males (81%) and 4 females (19%). All patients were referred from areas out of Samarinda. Patients’ ages were 13 to 56 years (mean age 34.1 years). The most common complications found were jaundice (57.1%), acute kidney injury (42.9%), cerebral malaria (33.3%). Moderate to severe anemia (Hb < 10 g/dl) was found in 47.6% of patients, only one patient had severe anemia (Hb < 5 g/dL). Mean Hb when admitted to hospital was 10.5 g/dL. Moderate to severe thrombocytopenia (platelet < 100,000/mL) was found in 90% of patients, with lowest platelet count 22,000/mL and mean platelet count when admitted was 79,000/ml. The highest total bilirubin level was 26.2 mg/dL and the highest serum creatinine level was 14 mg/dL. The majority of patients had 1 complication (57.1%), while patients with 2 and 3 or more complications were 33.3% and 9.5% respectively. Mortality was 28.6%, one patient was a first trimester pregnant woman. Conclusion: The most common complications of severe falciparum malaria in Samarinda are jaundice (57.1%), acute kidney injury (42.9%) and cerebral malaria (33.3%). Thrombocytopenia is found in almost all patients (90%) while anemia was found in a half of patients (47.6%). Mortality is 28.6%.