STUDY OF ADRENAL INSUFFICIENCY IN SEVERE FALCIPARUM MALARIA WITH SHOCK KEY WORDS: Falciparum Malaria, Shock, Adrenal

Abstract

Malaria remains a serious health problem in South East Asian Region (SEAR) with nearly 290 million people are estimated to be at high risk.India accounts for 77% of the regional total malarial cases.Most of deaths in malaria are due to severe falciparum malaria. Odisha is a unique state in the eastern region of India, which contributes 4% of the population and counting up to >40% of total falciparum malaria cases of India. Malaria is one of the most important public health disease in Odisha. In spite of such an important disease, there are many areas on severe falciparum malarias where research work is scanty. One among of them is detection of relative adrenal insufficiency in severe falciparum malaria. As there is limited work about the relative adrenal insufficiency in severe falciparum malaria with shock and its relation to mortality. This study has been undertaken with the following aims and objectives, firstly detection of relative adrenal insufficiency in severe falciparum malaria with shock and secondly to establish the relation of mortality with or without adrenal insufficiency in severe falciparum malaria.The present study has established that relative adrenal insufficiency is an important cause contributing to shock and increased mortality. Thus addition of corticosteroid saves life and must be used in the relative adrenal insufficiency. However the firm diagnosis of relative adrenal insufficiency depends upon estimation of basal serum cortisol level & post ACTH serum cortisol level. As corticosteroid reduces the mortality rate, it should be empirically used in critically ill severe falciparum malaria cases with shock.