title: Comparative features and outcomes of malaria at a tertiary care hospital in Karachi, Pakistan.
abstract: OBJECTIVE
  A comparison of clinical and laboratory features, diagnostic methods, drug treatment, and outcomes for patients hospitalized with malaria by Plasmodium species.
  
  
  METHODS
  Records of 521 patients hospitalized during the four and half-year study period were analyzed.
  
  
  RESULTS
  Infections were caused by Plasmodium vivax (51.8%), Plasmodium falciparum (46.5%), P. vivax plus P. falciparum (1.3%), and Plasmodium malariae (0.4%). Vomiting (odds ratio (OR)=1.86, p=0.001) and abdominal pain (OR=1.60, p=0.024) occurred more frequently in patients infected with P. falciparum compared to P. vivax; this was also the case for hepatomegaly, splenomegaly and jaundice. Low hemoglobin levels were common but were significantly lower with P. falciparum, and creatinine levels were significantly higher with P. falciparum. Treatment regimens consisted of single drug therapy (61.5%), appropriate combination therapy (15.8%), and inappropriate combination therapy (22.7%). Antimalarials given alone included chloroquine (38.7%), quinine (19%) and doxycycline (1.5%). The overall mortality was 1.7% (n=9) and nearly 56% of patients developed disease complications, most commonly thrombocytopenia (36.4%), anemia (23.4%), and thrombocytopenia plus anemia (32.7%).
  
  
  CONCLUSIONS
  Despite resistance, chloroquine was prescribed in patients with malaria requiring hospitalization. We found a high proportion of single antimalarial drug use as well as inappropriate combination therapy (22.7%), and inadequate use of primaquine terminal prophylaxis. Physicians need to be acquainted with malaria treatment guidelines in an endemic zone.
authors.affiliation: Department of Pathology and Microbiology, The Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, Pakistan. masim.beg@aku.edu
authors.forename: M A
authors.initials: MA
authors.lastname: Beg
authors.forename: N
authors.initials: N
authors.lastname: Sani
authors.forename: V
authors.initials: V
authors.lastname: Mehraj
authors.forename: W
authors.initials: W
authors.lastname: Jafri
authors.forename: M A
authors.initials: MA
authors.lastname: Khan
authors.forename: A
authors.initials: A
authors.lastname: Malik
authors.forename: E
authors.initials: E
authors.lastname: Menezes
authors.forename: R
authors.initials: R
authors.lastname: Hussain
authors.forename: R
authors.initials: R
authors.lastname: Smego
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D016780:Malaria, Vivax / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D011379:Prognosis; D012621:Seasons; D014839:Vomiting / Q000209:etiology
chemical_list: D000962:Antimalarials