Profile of Malaria: A Study of 250 cases in North Chennai

INTRODUCTION: Despite effects at vector control, malaria still remains a major public health problem. Malaria remains to be one of the world’s most prevalent infectious diseases. About 300 – 500 million cases are reported annually allover the world with a mortality of about 1.1 to 2.7 million. 90% of these cases are reported from Africa. In India, 2.5 to 3 million cases and 1000 deaths of malaria are reported annually. Many consider this is an underestimate. The parasite profile has been changing significantly over the years with a steady increase in percentage of PF cases across the country (50.5% of cases in 2005). Areas with more than 30% of PF cases are categorized as high risk. These include North East India, Orissa, Jharkand, West Bengal, Madhya Pradesh, Maharashtra & Andrapradesh. In Tamil Nadu 70% of malaria cases are reported from Chennai. Malaria is highly prevalent in places from North Chennai like Tondaiarpet, Washermanpet, Royapuram, Harbour, Mannady, Pattalam & Pulianthope. This study was undertaken at Stanley Medical College Hospital which is located in North Chennai. This study deals with Clinical and Laboratory profile of Malaria in North Chennai. AIM: To study the clinical profile of Plasmodium Vivax and Plasmodium Falciparum Malaria in North Chennai PATIENT AND METHODS: 1. Patients with fever, from north Chennai admitted to Stanley Medical College Hospital who were tested positive for plasmodium vivax /falciparum by peripheral smear study (Giemsa ) / QBC ( Quantitative Buffy Coat) were taken up for the study. 2. All the patients were evaluated for : a. Clinical features: • Intermittent paroxysm, • Head ache, • Chills, • Vomiting, • Diarrhea, • Icterus, • Hepatosplenomegaly, • Loss of consciousness, • Convulsions, • Altered behavior. b. Laboratory parameters: • Hemogram – Hb,TLC, DLC, platelet count, • Renal function – Serum urea, creatinine & electrolytes, • Blood sugar, • Liver function tests – Total bilirubin, Direct bilirubin, SGOT,SGPT & SAP. • ECG – to rule out any cardiac abnormality for quinine Administration, • Chest X – ray. Exclusion Criteria: Patients with leptospirosis, enteric fever and hepatitis were excluded by doing appropriate investigations. Patients co infected by both plasmodium vivax and falciparum were also excluded from the study. SUMMARY: 250 patients of malaria were analyzed.210 (84%) had Plasmodium vivax and 40 (16%) had Plasmodium Falciparum. • Complications of PF (n – 40) – Jaundice 47.5%, Anemia 27.5%, Renal failure 25%, Cerebral malaria 15%, ARDS 2.5%, Thrombocytopenia 5% and Hypoglycemia 5%. • Complications of PV (n – 210) - Jaundice 11.4%, Anemia 13.8%, Renal failure 7.6%, Cerebral malaria 12.5%, ARDS, Thrombocytopenia and Hypoglycemia in two cases, CVT in three cases. • Jaundice occurred in 11.4% of PV and 47.5% of PF cases. Mean Bilirubin noted was 5.3mg/dl, predominantly of direct bilirubinemia with mild elevations of transaminases in the range of 40 to 80 IU/L. This Shows that jaundice in malaria is predominantly of cholestatic in origin. • Renal failure occurred in 7.6% of PV and 25% of PF cases. Overall renal failure occurred in 10.6% of malaria. Mean creatinine and urea noted were 2.6mg/dl and 99.5mg/dl respectively. 76% of ARF was mild (Serum Creatinine 1.5 to 3mg/dl) • 48.8% of patients had Hb <10g/dl. Only three patients had Hb <5g/dl and 37 patients (14.8%) had Hb in the range of 5 to 8g/dl. 13.8% of PV and 23% of PF had Hb <8g/dl. Mean Hb noted was 8.5g/dl. • Cerebral malaria occurred in 13.2% of cases. Predominant presentations were altered behaviour, loss of conciousness (51%) and Generalized convulsions (48%). 12.8% of PV and 15% of PF patients had cerebral malaria. • Other complications are less common. They were ARDS 1.2%, Thrombocytopenia 1.6%, Hypoglycemia 1.6% and CVT 1.2%. • 42.4% were treated with chloroquine and 36% were treated with quinine in combination with Doxycycline. 19.2% were found to be chloroquine non responsive and later switched over to quinine with good response. • Artemisinin group of drugs used in six patients in whom quinine was contraindicated as they had ischemic heart disease. • Mortality – Four patients (1.6%) died, Three (1.4%) in Vivax and One (2.5%) in Falciparum. MODS was the cause of death in three out of four patients and one died of cerebral malaria. CONCLUSIONS: Plasmodium vivax occurred in 84% and Plasmodium falciparum in 16%. • Jaundice 47.5% and Renal failure (25%) were the important complications in Plasmodium Falciparum where as cerebral malaria occurred only in 15%. • All severe complications like jaundice(11.4%), renal failure (7.6%), cerebral malaria (12%), severe anemia (13.8%) and ARDS (1.2%) were noted in Plasmodium vivax though less common compared to Plasmodium falciparum. • Early detection of organ dysfunction utilizing Serum Creatinine >1.5mg/dl, total bilirubin >1.5mg/dl and Hb