Complicated Falciparum Malaria Research Articles

Monocyte platelet satellitism without thrombocytopenia in a follow-up case of recent complicated Falciparum malaria infection.

Monocyte platelet satellitism without thrombocytopenia in a follow-up case of recent complicated Falciparum malaria infection.

Delving into artemisinin’s shadow: Insights from a unique case of artesunate – resistant complicated falciparum malaria

The emergence of drug-resistant malaria poses a formidable health challenge in emerging nations such as India. The ineffectiveness of the medicine artemisinin, which is essential for treating malaria, will quickly undermine the treatment and outlook for malaria patients. If, following a complete course of therapy with Artesunate Combination Therapy and without any instances of vomiting or diarrhoea, there is no clinical or parasitological improvement in the patient within 72 hours, resistance may be considered. Reports of artemisinin-resistant Plasmodium falciparum malaria are rare in the southern regions of India. This article details a case of rare Artesunate-resistant complex falciparum malaria.

A case of complicated falciparum malaria from coming back from Myanmar-India border presenting with cerebral malaria, black water fever, acute kidney injury, metabolic acidosis, hypocalcemia, severe anemia, thrombocytopenia and hepatitis having early parasitological failure on Day 14: Awareness on dihydroartemisinine-piperaquine combination therapy

A-39-year-old migrant worker coming back from Palatwa (Sagaing Division) and Myanmar-India border area (Rakhine State) developed cerebral malaria

A study of clinical profile and outcome of malaria in adults at government general hospital, Nizamabad

What has to be stressed is the need to be cautious with such individuals and to broaden our differentials to include P. vivax as a possible cause of severe malaria. Patients who are aggressively handled and treated can have a better outcome.To study the clinical profile and outcome of malaria in adults at Government General Hospital in our local area. A Cross-sectional, observational study done in Department of general medicine in Fifty smear positive malaria patients admitted to the medical wards and intensive care units are included in the study. Study done for a period of 1 Year . Patients of either gender, above 18 years of age and below 60 years of age, diagnosed with malaria on peripheral smear were included in study.: A total number of 50 smear positive malaria patients were included in the study. Majority of the patients belongs to the age group of 18-30 years [36%] CNS findings: Altered Sensorium was seen in 20% patients and convulsions were seen in 20% patients. Complicated malaria was present in 76% patients and uncomplicated malaria was present in 24% patients. Complicated falciparum malaria was present in 30% patients and Complicated Vivax malaria was present in 46% patients. Uncomplicated falciparum malaria was present in 4% patients and Uncomplicated Vivax malaria was present in 20% patients. Mortality was seen in 6% patients. Mortality was seen in the age group of 41- 50 years [66.7%] and 31-40 years [33.3%]. : Malaria complications can be reduced by studying the clinical profile of the disease and using proper antimalarial medication treatment. This aids in the reduction of malaria morbidity and death, as well as the country's long-term economic prosperity.

A study of serum calcium level in cases of malaria in a tertiary care hospital

Background: Malaria is a tropical disease caused by Plasmodium species, commonly P. falciparum and P. vivax. Carpopedal spasm has been noted in many patients presenting with malarial fever. Most of the patients are later found to have hypocalcaemia. Hypocalcaemia associated with malaria can cause many clinical manifestations, including life threatening conditions such as arrhythmias, convulsions etc.Methods: A cross-sectional study was conducted with the aim to determine the prevalence and clinical profile of hypocalcaemia in different types of malarial fever. 88 patients of malarial fever were studied. Patients were stratified according to the species of plasmodium and into complicated and uncomplicated malaria. Total serum calcium level and QTc interval were analysed in each patient. Data collected were analysed.Results: Prevalence of hypocalcaemia in malaria was found to be 54.45% in our study. Hypocalcaemia was more prevalent in complicated malaria than uncomplicated malaria. Complicated falciparum malaria showed highest prevalence of hypocalcaemia. Status of complexity of malaria was not found to be related to occurrence of hypocalcaemia in any types of malaria. Prevalence of QTc prolongation in malaria was found to be 48.46%. Prevalence of QTc prolongation was found to be more in complicated malaria than uncomplicated malaria. QTc prolongation was most prevalent in complicated falciparum malaria. 83.3% of those with QTc prolongation had hypocalcaemia.Conclusions: Hypocalcemia and QTc prolongation were more prevalent in complicated malaria than in uncomplicated malaria. Both Hypocalcaemia and QTc prolongation were most prevalent in complicated falciparum malaria.

Malarial Retinopathy: Falci Not So Fan-See!

Malarial retinopathy is an established entity in cases of complicated falciparum malaria and cerebral malaria in children whereas, in adults it is rarely reported. Here we report a case of a 21-year-old male, with uncomplicated falciparum malaria, referred to the ophthalmology outpatient department with a chief complaint of sudden blurring of vision in both eyes. On examination, both eyes showed mild blurring of nasal optic disc margins with multiple intraretinal, preretinal haemorrhages, subhyaloid haemorrhage involving the macula and Roth spots, suggestive of malarial retinopathy. The patient was observed closely for spontaneous resolution and was treated systemically with anti-malarial drugs including injection artesunate and tablet doxycycline. On subsequent follow-up after 2 weeks, improvement in visual acuity with complete resolution of haemorrhages occurred. We aspire to bring to light a rare entity of malarial retinopathy and the need to not over-treat the condition.

Gambaran Histopatologi Ginjal Mencit (Mus musculus Balb/C) yang Diinfeksi dengan Plasmodium berghei

Background: P. berghei is a parasite that causes malaria in small rodents. This parasite is analogous to P. falciparum which causes severe malaria in humans with the highest risk of death compared to 4 other plasmodium species. Complications of falciparum malaria in renal microcirculation is AKI (Acute Kidney Injury). AKI is preceded by the incidence of ATN (Acute Tubular Necrosis) and MPGN (Mesangioproliferative Glomerulonephritis) with ATN being the highest prevalence.
 Objective: This study aims to determine the histopathological appearance of renal tubules of white mice Mus musculus Balb/C which are infected with P. berghei.
 Methods: Descriptive analysis method with quantitative approach is used in this study. The study was conducted at the Anatomical Pathology Laboratory of the Faculty of Medicine, Andalas University. The study was conducted since February to October 2020. The sample size was determined by the Federer formula (2008).
 Results: Percentage of renal tubular cell damage which were 8.42% for the control group, 4.52% for the pellet extract group, and 2.74% for supernatant extract group.
 Conclusion: The study concluded that highest percentage of kidney tubular cell damage was found in the kidney of mice immunization with the control group, and the lowest percentage of kidney tubular cell damage was found in the kidney of mice immunization with supernatant extract.

Long Term Followup of Sickle Cell Disease Post Hematopoietic Stem Cell Transplant from Uganda

Introduction: Sickle cell disease (SCD) remains associated with high risk of morbidity and early death. Many patients in sub-Saharan Africa continue to experience severe complications despite best supportive care. Hematopoietic stem cell transplant (HSCT) can be considered for a select group of patients. When successful, HSCT is economical and improves quality of life. We report the experience from our south-south partnership whereby Ugandan patients with SCD have undergone HSCT at the Bone Marrow Transplant Center in Gurgaon, IndiaMaterial and methods: 23 consecutive patients suffering from SCD who underwent HSCT between June 2014 and July 2017 were included in the study. Eleven underwent matched sibling donor bone marrow transplant (BMT) using busulfan 3.2 mg/kg/day for 4 days, cyclophosphamid 50mg/kg/day for 4 days, and hATG (PfizerATGAM) 30mg/kg/day for 3 days. Two adult patients underwent matched sibling donor HSCT using reduced intensity conditioning with busulfan 3.2 mg/kg/day for 4 days, cyclophosphamid 60mg/kg/day for 2 days, and ATG (PfizerATGAM) 30mg/kg/day x 3 days. Immune suppression for for HSCT patients was cyclosporine 3mg/kg/day in 2 divided doses starting D-4 and methotrexate 10mg/m2 on D+1 followed by 7mg/m2 on day 3, 6 and 11 post HSCT. Ten patients underwent haploidentical HSCT using hypertransfusion (target Hb 11-13gm/dl), hydroxyurea (20mg/kg/day) and azathioprine (2mg/kg/day) from day -45, conditioned with Thiotepa 10mg/kg in two divided doses (D-7), fludarabine 30mg/m2 (D-6 to D-2), cyclophosphamide 14.5 mg/kg (D-5, D-4), TBI 2Gy with thymic shielding (D-1), rATG (Genzyme Thymoglobulin) 1.5 mg/kg (D-9 to D-7). GVHD prophylaxis included PTCy 50 mg/kg/day on D3 and 4, tacrolimus (target level 5-15 ng/ml) or sirolimus (target levels 10-15ng/ml) (till 6 months post HSCT) and MMF (till D35) starting from D5.Results: The median patient age was 8 years (range 10 months-31 years). Before transplantation all patients had repeated episodes of SCD complications warranting a transplant. All were non-responsive to hydroxyurea. Of the 23 patients, 18 survived without sickle cell disease with Lansky/Karnofsky scores of 100. One had a primary graft failure another secondary graft failure with recurrence of disease. At median follow up of 479 days (range 51-1204) the probabilities of survival, SCD-free survival, and transplant-related mortality after transplant were 87%, 78%, and 13%, respectively. Three children who underwent haploidentical HSCT died. One died due to PRES with intracranial hemorrhage at day 86 post BMT, another one due to primary graft failure with Klebsiella sepsis with shock. The third child died due to complicated falciparum malaria and possible invasive fungal infection at day 24 post HSCT. He had full donor chimerism.Conclusion: Outcomes of HSCT in SCD have improved significantly. With better conditioning regimens and improved supportive care, alternative donor transplant and adult HSCT have become viable therapeutic options. HSCT should be strongly considered as a curative modality for selected patients suffering from SCD. DisclosuresNo relevant conflicts of interest to declare.

Optimizing the Intensive Care Treatment of Severe and Complicated Plasmodium falciparum Malaria in Nonimmune Patients.

This study analyses the intensive care treatment of 48 patients admitted to the Intensive Care Unit (ICU) at the Infectious Diseases Clinical Hospital No. 2, Moscow, Russia, between 2007 and 2019, with a severe and complicated form of P. falciparum malaria (B50.8 ICD 10). Objective. The aim of this study was to improve the intensive care treatment for severe and complicated P. falciparum malaria. The treatment strategy implemented was aimed at preventing ischaemia-reperfusion injury to organs, as well as haemorrhagic complications. The ICU Case Management Protocol set up indications for transferring patients to the ICU which provide preventive (prior to the development of renal failure) application of extracorporeal hemocorrection methods (continuous venous-venous hemodiafiltration and plasmapheresis in a plasma exchange mode) and mechanical ventilation under a medically induced coma, given impaired consciousness as the initial symptom of patients. Results. Successful treatment outcome in a majority of the patients (93.8%), shorter ICU length of stay (6.67 ± 1.9 days as compared to 94 ± 1.6 before introduction of the protocol), a median parasite clearance time of 37.50 hours (95% CI 36.21–38.18), and a reduced mortality rate from 29.1% to 6.25% support the efficacy of the ICU protocol in managing severe and complicated P. falciparum malaria.

REFRACTORY ANEMIA AND PANCYTOPENIA AS PRESENTATIONS OF FALCIPARUM MALARIA IN POPULATION OF KHYBER PAKHTUNKHWA, PAKISTAN

Background: Falciparum malaria is a common disease in our area. Apart from its classical presentation, at times it may present with refractory anemia or pancytopenia. The aim of this study was to determine the refractory anemia and pancytopenia as complications of falciparum malaria and apart from peripheral blood smears the significance of rapid antigen tests and bone marrow examination in the diagnosis of falciparum malaria. Material & Methods: The descriptive study included 200 consecutive cases of fever and refractory anemia or pancytopenia from 2011 to 2014. Stratification of patients according to the clinical scenario included Group-A having fever with refractory anemia and Group-B with fever and pancytopenia. A detailed history, thorough clinical examination, and pertinent laboratory tests were performed. All patients were treated with antimalarial drugs and followed-up for eight weeks. The pre and post treatment hematologic parameters were compared. Results: Among the 200 patients, 85 were males and 115 females. The age ranged from 15 to 55 years. Stratification of patients on clinical scenario revealed 175(87.5%) patients with fever and refractory anemia (Group-A). Among these, 125(62.5%) patients were reported smear positive for P. falciparum. In the remaining 50 smear negative patients rapid antigen tests were performed and all were reported positive. In 25 patients of Group B with fever and pancytopenia, the peripheral smear for malaria was positive only in 5 patients. In the remaining 20 cases both the peripheral blood smears and rapid antigen tests were reported negative. Bone marrow examination was planned to confirm the bone marrow suppression as the cause of peripheral pancytopenia, to exclude leukemia and to identify P. falciparum. The bone marrow examination revealed P. falciparum in all these cases. All the patients had a dramatic response to treatment with antimalarials in terms of disappearance of fever and correction of anemia and bone marrow rescue with reversal of pancytopenia to normal counts. Conclusion: Plasmodium falciparum should be considered in all cases of prolonged fever with refractory anemia or pancytopenia in malaria endemic areas, even with negative smear and rapid antigen tests. Bone examination is mandatory for the diagnosis in such cases. There is dramatic response of such patients to treatment with antimalarial drugs and hematinics.

Inhibition of EIF-5A prevents apoptosis in human cardiomyocytes after malaria infection.

In this study, a determination of Troponin I and creatine kinase activity in whole-blood samples in a cohort of 100 small infants in the age of 2-5years from Uganda with complicated Plasmodium falciparum malaria suggests the prevalence of cardiac symptoms in comparison to non-infected, healthy patients. Troponin I and creatine kinase activity increased during infection. Different reports showed that complicated malaria coincides with hypoxia in children. The obtained clinical data prompted us to further elucidate the underlying regulatory mechanisms of cardiac involvement in human cardiac ventricular myocytes. Complicated malaria is the most common clinical presentation and might induce cardiac impairment by hypoxia. Eukaryotic initiation factor 5A (eIF-5A) is involved in hypoxia induced factor (HIF-1α) expression. EIF-5A is a protein posttranslationally modified by hypusination involving catalysis of the two enzymes deoxyhypusine synthase (DHS) and deoxyhypusine hydroxylase. Treatment of human cardiomyocytes with GC7, an inhibitor of DHS, catalyzing the first step in hypusine biosynthesis led to a decrease in proinflammatory and proapoptotic myocardial caspase-1 activity in comparison to untreated cardiomyocytes. This effect was even more pronounced after co-administration of GC7 and GPI from P. falciparum simulating the pathology of severe malaria. Moreover, in comparison to untreated and GC7-treated cardiomyocytes, co-administration of GC7 and GPI significantly decreased the release of cytochrome C and lactate from damaged mitochondria. In sum, coadministration of GC7 prevented cardiac damage driven by hypoxia in vitro. Our approach demonstrates the potential of the pharmacological inhibitor GC7 to ameliorate apoptosis in cardiomyocytes in an in vitro model simulating severe malaria. This regulatory mechanism is based on blocking EIF-5A hypusination.

Laboratory diagnostic of human babesiosis.

Human babesiosis caused by parasitic protozoan Babesia spp. is sporadic zoonotic vector-borne infection. The course of babesiosis and prognosis depend on the type of pathogen and on the patient's immunological status. Significance this disease is a severe, often fatal course with immunocompromissed patients resembling complicated falciparum malaria. In Europe to date, more than 50 cases of confirmed human babesiosis have been reported in most cases caused by Babesia divergens. Possible there are unrecognized cases. Pathogen is an obligate intraerythrocyte parasite of vertebrate animals. The organism is transmitted from animal to man through bite of Ixodidae tick. Asexual reproduction of the parasite occurs in a vertebrate host. The pathogenesis of babesiosis is caused by the destruction of host cells. Intensive haemolysis of red blood cells leads to the development of haemolytic anemia, haematuria, jaundice, and polyorgan failure may develop. The clinical manifestations of the disease are nonspecific. Detection of intraerythrocyte parasites in blood smears stained Gimsa-Romanovsky confirms the proposed diagnosis. Blood smears and some laboratory signs from fatal cases were analyzed in the Reference-centre of E. I. Martsinovskiĭ Institute. Original microphotographs B. divergens are shown. The main morphological forms of the parasite are shown. In addition to the well-known tetrades of parasites «Maltese Cross», for the first time, the parasites dividing into 6 interconnected trophozoites - "sextet" - were found. Originally, the invasion of Babesia in a normoblast is shown. An unusually high multiple invasion (14 parasites) of erythrocytes is noted. Because the patients, initially, were incorrectly diagnosed with malaria, the differential diagnosis of Babesia with Plasmodium is described step-by-step. It is important, since the treatment with antimalarial drugs is ineffective. Deviation laboratory signs are discussed. Complex morphological characteristics allowed us to speciated the parasites as B. divergens. DNA was detected in the sample with specific primers Bab di hsp70F/Bab di hsp70R and the probe Bab di hsp70P. The sequence demonstrated 99-100% and 98% similarity to the 18S rRNA gene fragment of B. divergence and Babesia venatorum, respectively. Molecular biological and serological methods of laboratory diagnosis of babesiosis are considered.

Complicated Plasmodium vivax infection with malarial hepatopathy and splenic abscess

Malaria is a serious health burden in the tropical countries. Jaundice is a known manifestation of complicated falciparum malaria but is unusual with Plasmodium vivax infection. Only a few cases of vivax malarial hepatopathy have been reported till date. Here, we present a rare case of vivax malaria hepatopathy with secondary splenic abscess. No such case of dual complications of vivax malaria in the same patient has been reported till date to the best of our knowledge.

FALCIPARUM MALARIA

Objective: To determine how Falciparum Malaria can present clinically in various ways. A study conducted on 150 admitted patients. Subjects and Methods: This descriptive case-series, single center study was conducted in Medical B Unit, Khyber Teaching Hospital, Peshawar from November 2012 to June 2013. A total of 150 patients admitted with falciparum malaria were studied. A detailed history and clinical examination was performed. The falciparum malaria was diagnosed by examining peripheral blood film. All patients were thoroughly investigated to find out the complications of falciparum malaria. Results: Out of 150 patients, 95 (63.33%) were males 55 (36.67%) were females with mean age of 30 years. Fever was present in all patients, rigors and chills in 93%, headache and vomiting in 60%, jaundice in 50%, confusion in 37 %, abdominal pain in 26% were main presentations. Other presentations were Oliguria, hypotension, cerebral malaria, dyspnea and cough, hypoglycemia and seizures. Clinical examination showed splenomegaly (58%), hepatomegaly (46%), hepato-splenomegaly (22%) of patients. Laboratory investigation showed Hemoglobin < 10gm% in 22% and leukocytosis > 12000/μl in 10% of patients. Conclusions: As Falciparum Malaria presents in multiple ways clinically, it should be considered as a possibility in all febrile illnesses.

Lipid profiles among Plasmodium falciparum infected, non malarial febrile patients and volunteers

Background: Acute falciparum Malaria infected patients show wide ranges of metabolic derangement including changes in serum lipid profiles. The exact mechanisms of this derangement in serum lipid profiles are still poorly understood. Objective was to study the lipid profiles among acute plasmodium falciparum infected patients.Methods: It was a Prospective observational comparative study. A total of 100 patients were consecutively taken in the study. Fifty Non- malaria febrile cases and 50 healthy volunteers were taken as control group. Baseline lipid profiles were estimated in all cases at the time of admission and at the end of one week. Data were collected and analyzed.Results: There were 100 diagnosed cases of falciparum malaria and 50 non malarial febrile and 50 healthy volunteers taken as control group. Complications was present in 50 and 50 were uncomplicated. Serum total cholesterol, HDL and LDL levels were significantly low in falciparum malaria patients, and serum TG and VLDL levels were higher than control. There were no significant changes in mean serum lipids profiles in survived and deaths cases.Conclusions: The derangement in lipid profiles in falciparum malaria was characteristic and specific for the disease. Characteristic changes were lower HDL, LDL and total cholesterol levels and higher TG and VLDL levels in comparison to control groups. Changes are more pronounced in complicated falciparum Malaria and persisting till the end of the week. These findings may be of diagnostic and prognostic value.

Whole-Genome Sequencing of African Dogs Provides Insights into Adaptations against Tropical Parasites.

Natural selection in domestic dogs is of great interest in evolutionary biology since dogs have migrated to every inhabited continent of the world alongside humans, and adapted to diverse environments. Here, we explored their demographic history and genetic basis of adaptation to the tropical African environment using whole genome analyses of 19 African indigenous dogs from Nigeria. Demographic analysis suggests that the ancestors of these dogs migrated into Africa from Eurasia 14,000 years ago and underwent a severe founder effect before population expansion. Admixture analysis further reveals that African dog genomes contain about 1.88-3.50% introgression from African golden wolves (Canis anthus). Population genetic analysis identifies 50 positively selected genes linked with immunity, angiogenesis, ultraviolet protection, as well as insulin secretion and sensitivity that may contribute to adaptation to tropical conditions. One of the positively selected genes, adhesion G protein-coupled receptor E1 (ADGRE1), has also been found to be association with severe malaria resistance in African human populations. Functional assessments showed that ADGRE1 provides protective host defense against Plasmodium infections. This result, together with the fact that the inflammatory response to canine babesiosis is similar to complicated falciparum malaria in humans, support the dogs as a model for the study of malaria control and treatment.

English

Background: Sparse published data are available regarding clinical presentation and complications of falciparum malaria from Andhra Pradesh state. Methods: In this prospective, observational study conducted during the period November 2012 to June 2014 at our teaching hospital in Kuppam, Andhra Pradesh, adult patients (n=96) admitted with fever confirmed to be suffering from falciparum malaria based on peripheral blood smear examination and / or malaria antigen test positive by rapid diagnostic test were studied. The clinical presentation and various complications of falciparum malaria were documented. Results: The male to female ratio was 2:1. Majority of the patients (70%) were in the age group 26-60 years. Fever was present in all cases. Splenomegaly (66%) was the most common physical sign followed by pallor (31%) and icterus (22%). Anaemia (51%), was the most common complication, followed by cerebral malaria (33.3%), acute respiratory distress syndrome (ARDS) (32.3%), acute kidney injury (AKI) (29.2%), and jaundice (25%). Majority of the patients presented with multiple complications (73%) than single complication (27%). Artemesinin-based combination therapy was administered to 72 of the 96 patients of whom 43 patients recovered. Quinine therapy was given to 14 patients of whom 10 recovered. Quinine plus ACT combination therapy was given to 10 patients and 7 recovered. seven of the 96 patients died; and 29 out of 96 patients were taken home against medical advice. Overall 36/96 (37.5%) patients had a poor outcome. All 7 patients who expired had multiple complications. Mortality was higher in patients who had co-existent AKI, hypotension and cerebral malaria. Conclusion: Early identification of high risk cases and institution of prompt treatment can reduce the mortality rate in falciparum malaria.

Symmetric peripheral gangrene: A rare complication of Plasmodium falciparum malaria

Sudden onset of symmetric peripheral gangrene (SPG) is a relatively uncommon clinical entity manifested by distal ischemic damage at two or more sites in the absence of large vessel obstruction. Here, we report a case of a 27-year-old female with complicated falciparum malaria with SPG involving the toes of both the lower limbs.

Observation on relationship of hepatic and renal dysfunction with haemorrheological parameters in plasmodium falciparum malaria in Kosi region, Bihar, India

Background: Malaria contribute to be one of the major public health problem in around 1.5 million contribute per year, of which about 52% due to Plasmodium falciparum. The study was designed to assess hepatic and renal dysfunction in plasmodium falciparum malaria, and evaluate if such abnormalities had any bearing with the haemorrheological dysfunction. Methods: Group A comprising 30 cases of plasmodium falciparum positive cases with jaundice or renal failure or both and Group B Comprising 30 cases of falciparum malaria and have no complication. Laboratory investigation was done for liver and renal function test, complete blood count and coagulation profile. The data collected was analysed to inter-correlate parameters of hepatic, renal and haemorrheological dysfunction. Results: Fever was the predominant feature in our study, present in 100% patient followed by chill and rigors which was present in 90% cases of both groups. Hepatomegaly was present in 53.33% cases in group A and 16.67% in group B, whereas spleenomegaly was present in 43.33% cases in group A and 26.67% in group B. Most common complication in group A was jaundice present in 100% cases followed by renal failure present in 53.33% cases. Overt bleeding was present in only 3.33% cases with complicated falciparum malaria. Anemia was present in 73.33% cases of group A and 50% cases in group B. Thrombocytopenia was present in 50% patient in group A and 23.33% in group B. Bleeding time, clotting time, PT with INR, APTT, FDP and LDH was much higher in group A than group B in our study. The biochemical parameters (serum urea, creatinine, bilirubin, AST, ALT, ALP) in both groups differed significantly. In group A Haemoglobin and platelet count significantly negatively correlated with hepatic and renal parameters where as FDP and LDH significantly positively correlated with all the hepatic and renal parameters. In group B the correlation between hematological and biochemical (hepatic and renal) parameters was not found to be statistically significant. Conclusions: Patients of complicated falciparum malaria have significant subclinical haemorrheological disorders even if they do not manifest as clinically overt DIC.

The clinical and biochemical features of complicated falciparum malarial nephropathy.

ObjectiveThis study aimed to explore renal involvement in complicated falciparum malaria as observed in hospitalized children.MethodsThis prospective study was conducted for four consecutive years with children 6 months to 14 years old who were affected by malarial nephropathy. Malaria was confirmed by microscopic examination of a blood smear. Detailed clinical evaluation and investigations were carried out to determine multi-organ involvement with special emphasis on renal functions. The staging for Acute Kidney Injury (AKI) was carried out as per Acute Kidney Injury Network Staging, which provided three groups of patients who were further modified by Risk, Injury, Failure, Loss, End stage renal disease (RIFLE) staging.ResultsOut of 350 cases with malaria, 56 (16%) cases had nephropathy. One-hundred-forty cases (40%) were aged between 5 and 10 years. Serious renal involvement was observed in 14 (25%) children who were 10–14 years old. Oligo-anuria was found in 40 (71.4%) cases, and generalized oedema was found in 33 (58.9%) children from the onset of malaria. Approximately 47 cases showed associated multi-organ dysfunction, and 9 cases had isolated renal failure. Malaria-induced hepatopathy and nephropathy had a higher risk of death than nephropathy alone.ConclusionThe spectrum of malarial nephropathy in children is highly variable, ranging from asymptomatic proteinuria to advanced stages of AKI. Renal involvement is more common and severe in P. falciparum. Children aged between 5 and 14 years and those with oligo-anuria, symptomatic azotaemia, electrolyte abnormalities and hepatopathy are more likely to develop advanced stage AKI and subsequently have an increased risk of mortality.