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• W2897544936 abstract "INTRODUCTION:Despite effects at vector control, malaria still remains a major public health problem. Malaria remains to be one of the world’s most prevalent infectious diseases. About 300 – 500 million cases are reported annually allover the world with a mortality of about 1.1 to 2.7 million. 90% of these cases are reported from Africa. In India, 2.5 to 3 million cases and 1000 deaths of malaria are reported annually. Many consider this is an underestimate. The parasite profile has been changing significantly over the years with a steady increase in percentage of PF cases across the country (50.5% of cases in 2005).Areas with more than 30% of PF cases are categorized as high risk. These include North East India, Orissa, Jharkand, West Bengal, Madhya Pradesh, Maharashtra & Andrapradesh. In Tamil Nadu 70% of malaria cases are reported from Chennai. Malaria is highly prevalent in places from North Chennai like Tondaiarpet, Washermanpet, Royapuram, Harbour, Mannady, Pattalam & Pulianthope. This study was undertaken at Stanley Medical College Hospital which is located in North Chennai. This study deals with Clinical and Laboratory profile of Malaria in North Chennai.AIM:To study the clinical profile of Plasmodium Vivax and Plasmodium Falciparum Malaria in North ChennaiPATIENT AND METHODS:1. Patients with fever, from north Chennai admitted to Stanley Medical College Hospital who were tested positive for plasmodium vivax /falciparum by peripheral smear study (Giemsa ) / QBC ( Quantitative Buffy Coat) were taken up for the study.2. All the patients were evaluated for :a. Clinical features:• Intermittent paroxysm,• Head ache,• Chills,• Vomiting,• Diarrhea,• Icterus,• Hepatosplenomegaly,• Loss of consciousness,• Convulsions,• Altered behavior.b. Laboratory parameters:• Hemogram – Hb,TLC, DLC, platelet count,• Renal function – Serum urea, creatinine & electrolytes,• Blood sugar,• Liver function tests – Total bilirubin, Direct bilirubin,SGOT,SGPT & SAP.• ECG – to rule out any cardiac abnormality for quinineAdministration, • Chest X – ray.Exclusion Criteria:Patients with leptospirosis, enteric fever and hepatitis were excluded by doing appropriate investigations. Patients co infected by both plasmodium vivax and falciparum were also excluded from the study.SUMMARY:250 patients of malaria were analyzed.210 (84%) had Plasmodium vivax and 40 (16%) had Plasmodium Falciparum.• Complications of PF (n – 40) – Jaundice 47.5%, Anemia 27.5%, Renal failure 25%, Cerebral malaria 15%, ARDS 2.5%, Thrombocytopenia 5% and Hypoglycemia 5%.• Complications of PV (n – 210) - Jaundice 11.4%, Anemia 13.8%, Renal failure 7.6%, Cerebral malaria 12.5%, ARDS, Thrombocytopenia and Hypoglycemia in two cases, CVT in three cases.• Jaundice occurred in 11.4% of PV and 47.5% of PF cases. Mean Bilirubin noted was 5.3mg/dl, predominantly of direct bilirubinemia with mild elevations of transaminases in the range of 40 to 80 IU/L. This Shows that jaundice in malaria is predominantly of cholestatic in origin.• Renal failure occurred in 7.6% of PV and 25% of PF cases. Overall renal failure occurred in 10.6% of malaria. Mean creatinine and urea noted were 2.6mg/dl and 99.5mg/dl respectively. 76% of ARF was mild (Serum Creatinine 1.5 to 3mg/dl)• 48.8% of patients had Hb <10g/dl. Only three patients had Hb <5g/dl and 37 patients (14.8%) had Hb in the range of 5 to 8g/dl. 13.8% of PV and 23% of PF had Hb <8g/dl. Mean Hb noted was 8.5g/dl.• Cerebral malaria occurred in 13.2% of cases. Predominant presentations were altered behaviour, loss of conciousness (51%) and Generalized convulsions (48%). 12.8% of PV and 15% of PF patients had cerebral malaria.• Other complications are less common. They were ARDS 1.2%, Thrombocytopenia 1.6%, Hypoglycemia 1.6% and CVT 1.2%.• 42.4% were treated with chloroquine and 36% were treated with quinine in combination with Doxycycline. 19.2% were found to be chloroquine non responsive and later switched over to quinine with good response.• Artemisinin group of drugs used in six patients in whom quinine was contraindicated as they had ischemic heart disease.• Mortality – Four patients (1.6%) died, Three (1.4%) in Vivax and One (2.5%) in Falciparum. MODS was the cause of death in three out of four patients and one died of cerebral malaria.CONCLUSIONS:Plasmodium vivax occurred in 84% and Plasmodium falciparum in 16%.• Jaundice 47.5% and Renal failure (25%) were the important complications in Plasmodium Falciparum where as cerebral malaria occurred only in 15%.• All severe complications like jaundice(11.4%), renal failure (7.6%), cerebral malaria (12%), severe anemia (13.8%) and ARDS (1.2%) were noted in Plasmodium vivax though less common compared to Plasmodium falciparum.• Early detection of organ dysfunction utilizing Serum Creatinine >1.5mg/dl, total bilirubin >1.5mg/dl and Hb <8g/dl is valuable in diagnosing complicated malaria early and starting aggressive management (Quinine and Doxycycline), thereby preventing further morbidity and mortality." @default.
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• W2897544936 date "2007-03-01" @default.
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• W2897544936 title "Profile of Malaria: A Study of 250 cases in North Chennai" @default.
• W2897544936 hasPublicationYear "2007" @default.
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