Dipen Kumar Bhattacharyya1, Abdul Barik Ahmed2, Bhabadev Goswami3, Rupam Hazarika4, Debabrata Goswami5
An alarming incidence and severity of jaundice in Malaria, especially in the Plasmodium falciparum variety, has been reported from various parts of the world and at times it causes diagnostic dilemma in both endemic and non-endemic areas, even sometimes affecting the outcome adversely. There are reports depicting association of severe jaundice with falciparum malaria masquerading as fulminant hepatic failure. This study is done to clinically evaluate the cases of malaria with hepatitis in terms of its presentations, extent of hepatic involvement and biochemical parameters.
MATERIAL AND METHOD
This study was done on 100 confirmed cases of malaria with jaundice, who were admitted in Gauhati Medical College and Hospital during a period of 12 months (1st July 2012 to 30th June 2013). Patients were admitted due to complications of malaria like jaundice, nausea and vomiting, pain abdomen, respiratory difficulty, oliguria, altered sensorium, etc. Detailed history, clinical examination, biochemical parameters for liver function test and other blood tests were done in all patients.
Age of the patients ranged from 13-55 years. Among all patients, 96% cases were P. falciparum and 4% cases were P. vivax. Fever and jaundice were present in 100% of cases. Among the cases, 14% had only splenomegaly, 30% had only hepatomegaly whereas 56% had enlargement of both the organs. The mean serum bilirubin level was 8.9 ± 8 mg/dL with predominantly conjugated hyperbilirubinaemia. Majority of the cases had elevated transaminases and alkaline phosphatase levels. Lowering of serum albumin level and derangement of prothrombin time was also noted in more than half of the patients while serum ammonia was elevated in small number of cases. Acute renal failure and cerebral malaria were the other complications noted frequently in cases of Malaria presenting with jaundice.
The evidence of predominant conjugated hyperbilirubinaemia, increased levels of liver enzymes along with relative changes in other important parameters are strong evidence of gross hepatocytic dysfunction in patients of malaria. Awareness about these possible alterations are pertinent towards proper diagnosis and treatment of cases of Malaria with jaundice.