title: The emerging trends of falciparum malaria: a study from a tertiary centre in an endemic area of India.
abstract: OBJECTIVE
  To document the various clinical manifestations, lab parameters, complications and outcomes of Falciparum Malaria. The above data would be correlated with the parasitic index to deduce whether it would be an effective measure of the same.
  
  
  METHODS
  This was a prospective study among 183 inpatients aged above 18 from Kasturba Hospital, Manipal from May 2009 to January 2011. Ethical clearance was taken. Statistical analysis was done with the independent paired t test, linear correlation and Chi square test using SPSS 16.
  
  
  RESULTS
  In this study 78% cases were males. Most cases occurred during the monsoons. Fever was the major presentation with others being jaundice, vomiting and head ache. 50.8 % had complications, including hepatic dysfunction (40.9%), renal failure (19.13%), shock (7%), altered sensorium (9%), ARDS (3.27%) and severe anemia (1.63%). Hypoglycemia and gram negative sepsis were rare. Parasitic index, renal parameters and death were correlating positively. ESR was significantly related (P<0.003) to complications and not to cerebral malaria. There were 12 mortalities out of which 9 were due to MODS and 3 due to ARDS.
  
  
  CONCLUSIONS
  50.8% cases conformed to the WHO definition of severe malaria indicating most present with complications. High parasite index and abnormal renal function are predictors of mortality and complications. Early diagnosis, anticipation of complications, close monitoring and combination therapy to over come drug resistance helps to contain the extent of mortality.
authors.affiliation: Department of Medicine, KMC Manipal, Udupi, Karnataka- 576102, India.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Poovathingal
authors.affiliation: Department of Medicine, KMC Manipal, Udupi, Karnataka- 576102, India.
authors.forename: Shivashankara Kaniyoor
authors.initials: SK
authors.lastname: Nagiri
authors.affiliation: Department of Medicine, KMC Manipal, Udupi, Karnataka- 576102, India.
authors.lastname: Nagaraja
keywords: Complications of malaria; ESR and cerebral malaria; Falciparum malaria; Parasitic index; Renal failure in malaria; Severe malaria