The changing spectrum of severe falciparum malaria: a clinical study from Bikaner (northwest India)

Abstract

Background & objectives: Recently there were reports from all over India about changing spectrumof clinical presentation of severe malaria. The present study was planned to study the same in thenorthwest India.Methods: This prospective study was conducted on patients of severe malaria admitted in a classifiedmalaria ward of a tertiary care hospital in Bikaner, Rajasthan (northwest India) during 1994 and 2001.It included adult patients of both sexes belonging to all age groups. The diagnosis of Plasmodiumfalciparum was confirmed by demonstrating asexual form of parasites in peripheral blood smear. Allpatients were treated with i.v./oral quinine. The specific complications were treated by standard WHOprotocol. The data for individual complications for both the years were analysed by applying chisquaretest.Results: In a prospective study in 1994 the spectrum of complication was dominated by cerebralmalaria (25.75%) followed by jaundice (11.47%), bleeding tendencies (9.59%), severe anaemia(5.83%), shock (5.26%), Acute respiratory distress syndrome—ARDS (3.01%), renal failure (2.07%)and hypoglycemia (2.07%) whereas in 2001 it was dominated by jaundice (58.85%) followed bysevere anaemia (26.04%), bleeding tendencies (25.52%), shock (10.94%), cerebral malaria (10.94%),renal failure (6.25%), ARDS (2.08%) and hypoglycemia (1.56%). The sharp difference for presence ofjaundice and severe anaemia in 2001 and cerebral malaria in 1994 was statistically significant. Similarly,the important cause of mortality in 2001 was multiple organ dysfunction syndrome (71.10%) withpredominant presentation of jaundice and renal failure, whereas in 1994, it was cerebral malaria (77.96%).Interpretation & conclusion: The observation of changing spectrum of severe malaria in this studyand a significant increase in presentation with jaundice as an important manifestation is highly essentialfor primary, secondary and tertiary level health care providers for proper diagnosis and management