Clinical Profile of Malaria in and around Hubballi-Dharwad: A Region of North Karnataka

Introduction: Malaria is an endemic vector borne parasitic infection. Plasmodium vivax has been associated with severe malaria while P. falciparum is traditionally associated with severe course. Of late, P. vivax is increasingly reported to cause severe and life threatening disease. However, majority of P. vivax are sensitive to antimalarials and therefore, it is important to speculate this pathogen. Aim: To study the clinical profile of confirmed malaria cases. Materials and Methods: This prospective study was undertaken at SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India, between the period of 2010 to 2012 for the duration of two years. A total of 124 clinically suspected malaria cases aged from 8 years to 65 years were included in the study. Laboratory identification was done by Quantitative Buffy Coat (QBC). A comparative analysis of clinical presentations in 62 QBC positive samples and an equal number of age and sex matched QBC negative was done. Results: Out of 62 QBC positive samples, Plasmodium vivax was seen in 40/62 (64.52%) patients while P. falciparum in 10/40 (16.13%) cases. Mixed infection by P. vivax and P. falciparum was seen in 12/40 (19.35%) cases. Fever, chills and headache were common symptoms. Pallor was seen in 23/40 (37.1%) cases and icterus, splenomegaly and vomiting were seen in 14/62 (22.6%) cases followed by hepatosplenomegaly in 11 (17.7%) cases. Among QBC negative controls, fever (100%), chills 51/62 (82.3%), rigors 21/62 (33.9%) and pain abdomen (24.2 %) were the common symptoms. Pallor and hepatomegaly was seen in 19.4 % and 11.3% respectively among the QBC negatives. Ten out of 11 (90.9%) of females and 37/51 (72.5%) of males suffering from malaria had anaemia. Thrombocytopenia was seen in 59/62 (95.2%) cases of which 33 cases had moderate thrombocytopenia (53.2%) while 17 cases had severe thrombocytopenia. In QBC negative controls, severe thrombocytopenia was noted in 4 (6.5%) samples, mild and moderate thrombocytopenia was seen in 14 and 16 (22.5 and 25.8%) patients respectively. About 94% cases recovered completely. One patient suffering from P. vivax succumbed to the infection. Conclusion: Plasmodium vivax, traditionally thought to cause benign malaria can also produce life threatening complications similar to falciparum malaria. Early recognition of signs and symptoms of severe malaria and laboratory confirmation of species is most important in management of this condition