Jaundice with hepatic dysfunction in P. falciparum malaria.
To evaluate the frequency and severity of jaundice with hepatic dysfunction in Plasmodium (P.) falciparum malaria in adult patients admitted in the hospital.


METHODS
Descriptive study.


METHODS
The Infectious Diseases Unit and Medical Wards at Rashid Hospital, Dubai, United Arab Emirates, from January 2005 to December 2007.


METHODS
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.


RESULTS
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%).


CONCLUSIONS
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.
Abro
Ali Hassan
AH
Infectious Disease Unit, Rashid Hospital, Dubai, UAE. ahabro@dohms.gov.ae
Ustadi
Abdulla Mahmood
AM
Abro
Hakim Ali
HA
Abdou
Ahmed Saleh
AS
Younis
Nadim Javeed
NJ
Akaila
Suhail Ismail
SI
D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007565:Jaundice / Q000453:epidemiology / Q000209:etiology* / Q000469:parasitology; D008107:Liver Diseases / Q000453:epidemiology / Q000209:etiology* / Q000469:parasitology; D008111:Liver Function Tests; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum; D011739:Pyrimethamine / Q000627:therapeutic use; D012307:Risk Factors; D013413:Sulfadoxine / Q000627:therapeutic use; D014479:United Arab Emirates / Q000453:epidemiology; D055815:Young Adult
D000962:Antimalarials; D013413:Sulfadoxine; D000410:Alanine Transaminase; D011739:Pyrimethamine