Jaundice with hepatic dysfunction in P.faldparum malaria

To evaluate the frequency and severity of jaundice with hepatic dysfunction in Plasmodium [P.] falciparum malaria in adult patients admitted in the hospital. Descriptive study. The Infectious Diseases Unit and Medical Wards at Rashid Hospital, Dubai, United Arab Emirates, from January 2005 to December 2007. This study included 105 adult patients who fulfilled the inclusion criteria. The diagnosis of P.falciparum malaria was confirmed by examination of thin and thick film stained with Leishman's stain. Other laboratory investigations included full blood count, liver function tests, blood urea, electrolytes, serum creatinine, reticulocyte count, blood sugar, viral hepatitis serology and coagulation profile. Patient with significant clinical/biochemical hepatic dysfunction were also subjected to ultrasonic examination of abdomen. On clinical examination, 23% patients were found to be jaundiced. Serum alanine amino transferase [ALT] level was above the reference range in 67.6%, but in only 11.4%, ALT was more than 3 times of normal level. Serum bilirubin was found to be higher than normal level in 81%, however, only in 23% of the patients, Serum bilirubin was >3mg/dl. Predominantly conjugated hyperbilirubinemia was observed in patients with high ALT. There was no significant change in serum albumin and prothrombin time. In comparison to normal bilirubin level, the patient with bilirubin >3mg/dl had high frequency of raised ALT 87.5% vs. 45% [p <.0001], thrombocytopenia 91.6% vs. 65% [p <.01], anemia 70.8% vs. 25% [p <.05] and renal impairment 50% vs. 20% [p >.05]. Overall, 5 [4.7%] patients died and mortality rate was high among the patients with bilirubin level >3mg/dl than with normal bilirubin level 4 [16.6%] vs 1 [5%]. Hepatic dysfunction in acute P.falciparum malaria ranged from mild elevation of liver enzymes to acute hepatitis [ALT >/= 10 times of normal level]. It indicates severe illness with high frequency of complication and mortality rates

Malaria and hematological changes

The hematological changes associated with acute malaria are well recognized. This study was conducted to assess and compare the incidence and severity of hematological changes in various types of malaria in adult population. This observational study included 133 acute malaria patients admitted in the Infectious Diseases Unit of Rashid Hospital Dubai [JCI accredited] UAE, during January 2005 to December 2007. The diagnosis of malaria was confirmed by thick and thin film stained with Leishman,s staining for malarial parasite. Slides were reviewed by hematologist and FBC were performed using an automated Beckman Coulter machine. Overall 83% of the patient had thrombocytopenia, 64% anemia, 24% lymphopenia and 10% monocytosis. The incidence of thrombocytopenia was slightly more in P. Falciparum [87%] than P. Vivax [81%] cases, p value > 0.05, where as there was no significant difference in the incidence of anemia in two groups [67% vs 63%]-p value > 0.05. However, lymphopenia was observed in 36% in P. Vivax as compared to 15% in P.Falciparum cases, p value < 0.04. Eosinophil and basophil count was normal in both groups. P.Falciparum as well as P.Vivax can cause significant hematological changes with high frequency of thromboctopenia, anemia lymphopenia and monocytosis