title: Clinical Profile and Prognostic Indicators in Adults Hospitalized with Severe Malaria Caused by Different Plasmodium Species.
abstract: BACKGROUND
  Severe malaria remains a major cause of death and morbidity among adults in the Asiatic tropics. This study was planned to evaluate clinical profile and prognostic indicators of severe malaria in adults so as to improve insight into this highly prevalent disease.
  
  
  METHODS
  This prospective observational study was conducted on 60 confirmed cases of malaria. Cases were divided into two groups: (a) study group: suffering from severe malaria and (b) control group: no severe manifestations. All cases were thoroughly studied for clinical features, laboratory evaluation, and outcome. Prognostic evaluation was also done by different score systems.
  
  
  RESULTS
  In all, 40 cases suffer from severe malaria (study group), while 20 cases belong to the control group. The majority of our cases were males of age 21-40 years. The most common species of malaria in the study group was vivax (52.5%), followed by falciparum (25%) and mixed malaria species (22.5%). The clinical predictors for severe malaria were rural habitat, longer duration of fever, marked chills, tiredness, giddiness, nausea, vomiting, decreased urine output, jaundice, and altered sensorium. Extreme weakness (80%), jaundice (55%), renal failure (50%), and severe anemia (27.5%) were the most common presenting features in severe malaria. Two patients died of severe mixed malaria. The mortality rate was significantly associated with lower hemoglobin level (P = 0.002); higher total leukocyte count (P = 0.006), blood urea (P < 0.001), serum creatinine (P < 0.001), SGOT (P = 0.001), SGPT (P < 0.007), serum bilirubin (P = 0.003), and parasite density (P = 0.033); lower platelet count (P = 0.043); and those who had more APACHE II score (P = 0.003), SOFA score (P = 0.04), and Multiple Organ Dysfunction Score (P < 0.001) and lower Glasgow Coma Scale (P < 0.001).
  
  
  CONCLUSIONS
  Manifestations of severe malaria is becoming increasingly more prevalent specifically in vivax and mixed malaria cases. Our study proposes that there are certain clinical predictors and prognostic indicators that should be kept in mind for better management of severe malaria.
authors.affiliation: Senior Professor, In-charge Medical ICU, Department of Medicine, Sardar Patel Medical College, PBM Hospital, Bikaner, Rajasthan, India.
authors.forename: Bal Kishan
authors.initials: BK
authors.lastname: Gupta
authors.affiliation: Associate Professor, Department of Microbiology, Sardar Patel Medical College, PBM Hospital, Bikaner, Rajasthan, India.
authors.forename: Anjli
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Assistant Professor, Department of Medicine, Sardar Patel Medical College, PBM Hospital, Bikaner, Rajasthan, India.
authors.forename: Hardev Ram
authors.initials: HR
authors.lastname: Nehra
authors.affiliation: Senior Resident, Department of Medicine, Sardar Patel Medical College, PBM Hospital, Bikaner, Rajasthan, India.
authors.forename: Heera Ram
authors.initials: HR
authors.lastname: Balotia
authors.affiliation: Assistant Professor, Department of Medicine, Sardar Patel Medical College, PBM Hospital, Bikaner, Rajasthan, India.
authors.forename: Shyam Lal
authors.initials: SL
authors.lastname: Meena
authors.affiliation: Associate Professor, Department of Medicine, Sardar Patel Medical College, PBM Hospital, Bikaner, Rajasthan, India.
authors.forename: Surendra
authors.initials: S
authors.lastname: Kumar
keywords: Plasmodium falciparum; Plasmodium vivax; clinical predictor; mixed malaria; prognostic indicators; severe malaria