OUTCOME AND CLINICAL SPECTRUM OF CHILDREN ADMITTED WITH VARIOUS MALARIAL SPECIES

Objective: The purpose of this study was to compare the spectrum of clinical symptoms, hospital history, and treatment outcomes of children diagnosed with different types of malaria. Methods: This was a descriptive cross-sectional study conducted in the pediatric Unit-II of Bahawal Victoria Hospital (BVH) Bahawalpur for two-years duration from October 2018 to October 2020. Children 1-14 years old admitted to the Pediatric Department diagnosed with malaria by peripheral swab or immuno-chromatography. Biological data, clinical presentation, and outcome were recorded. All children received supportive and anti-malarial treatments. Results: Of the 2,357 children who visited the emergency department, 400 of them were diagnosed with malarial parasitemia. Two-thirds (65.2%) were infected with Plasmodium falciparum. In the falciparum group the symptom age was often less than 5 years (70%), in 90.4% intermittent fever was observed; jaundice in 21.8%, visceral enlargement in 62%, thrombocytopenia in 61%, and the neurological picture in 11.5% of cases. 16 children (6.1%) died from complications of malaria. Plasmodium vivax (P.v) induced parasitemia was found in 114 children (28.5%). In vivax patients the frequent age of presentation was less than 5 years (69%), intermittent fever was reported in 86.8%; jaundice in 20.2% and thrombocytopenia in 70%. Overall, 25 (6.2%) children were diagnosed with a mixed infection with both falciparum and vivax. In this group, jaundice occurred in 52% of cases, and spleen enlargement in all children. Mortality in mixed infections was high compared to the falciparum and vivax groups (p-0.04). Conclusion: It is clear from this study that malaria can manifest itself in many ways like any other disease and can mislead the diagnosis. The most common symptoms were fever, visceromegaly and thrombocytopenia. Mixed infection resulted in higher mortality. Keywords: malaria, clinical presentations, complication, outcome, mortality, children