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Prognostic factors in severe and complicated malaria

Hiren P Pandya, Prashant Bhansali.


Background: The spectrum of clinical picture of malaria ranges from the most benign febrile illness, which is completely curable with a simple course of chloroquine tablets to the most serious and life-threatening illness, even with very drastic therapeutic measures. That is the reason that has led to the studies from different parts the world to find out the clinical and laboratory parameters that may show a prognostic significance in this very common and frequently encountered condition.

Objective: (1) To identify the various clinical and laboratory parameters showing prognostic significance in severe and complicated malaria; (2) to study the relationship of these factors with mortality and morbidity; and (3) to find out the therapeutic outcome with various antimalarial drugs in such severe and complicated malaria cases.

Materials and Methods: A cross-sectional, observational study was carried out in LG Hospital, Ahmedabad. Adult patients of both the sexes admitted that clinical history suggestive of severe and/or complicated illness were included in the study.

Result: In this study, 100 adult male and female patients were studied. The male to female ratio was 3:2. The maximum number of patients was in the age range of 31–40 years. The overall mortality in this study was 10%, with more number (25%) of older patients showing fatal outcome with severe and complicated malaria. Anemia (35%) was the most common complication but with less mortality. Only one patient with Plasmodium vivax lead to fatal outcome, but he also showed very high parasitemia (grade IV), and the cause of death was acute respiratory distress syndrome.

Conclusion: Mortality is higher with Plasmodium facliparum malaria. Organ dysfunction is associated with higher mortality and is a sign of poor prognosis. Anemia, hypoglycemia, coma, convulsion, organ dysfunction, lactic acidosis hyperparasitemia, and leucocytosis are the prognostic factors in severe and complicated malaria as defined by the WHO. They are easily detectable and treatable and, hence, signify the importance of an early detection of these complications to decrease the morbidity and mortality owing to severe and complicated malaria.

Key words: Malaria, complicated, severe, prognostic factors, mortality

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