Jaundice with hepatic dysfunction in P. falciparum malaria

Abstract

To evaluate the frequency and severity of jaundice with hepatic dysfunction in Plasmodium (P.) falciparum malaria in adult patients admitted in the hospital.

Study design: Descriptive study.

Place and duration of study: The Infectious Diseases Unit and Medical Wards at Rashid Hospital, Dubai, United Arab Emirates, from January 2005 to December 2007.

Methodology: This study included 105 adult patients who fulfilled the inclusion criteria. The diagnosis of P.falciparum malaria was confirmed by examination of thin and thick film stained with Leishman's stain. Other laboratory investigations included full blood count, liver function tests, blood urea, electrolytes, serum creatinine, reticulocyte count, blood sugar, viral hepatitis serology and coagulation profile. Patient with significant clinical/biochemical hepatic dysfunction were also subjected to ultrasonic examination of abdomen.

Results: On clinical examination, 23% patients were found to be jaundiced. Serum alanine amino transferase (ALT) level was above the reference range in 67.6%, but in only 11.4%, ALT was more than 3 times of normal level. Serum bilirubin was found to be higher than normal level in 81%, however, only in 23% of the patients, Serum bilirubin was >3mg/dl. Predominantly conjugated hyperbilirubinemia was observed in patients with high ALT. There was no significant change in serum albumin and prothrombin time. In comparison to normal bilirubin level, the patient with bilirubin >3mg/dl had high frequency of raised ALT 87.5% vs. 45% (p<.0001), thrombocytopenia 91.6% vs. 65% (p<.01), anemia 70.8% vs. 25% (p<.05) and renal impairment 50% vs. 20% (p>.05). Overall, 5 (4.7%) patients died and mortality rate was high among the patients with bilirubin level>3mg/dl than with normal bilirubin level 4 (16.6%) vs 1 (5%).

Conclusion: Hepatic dysfunction in acute P.falciparum malaria ranged from mild elevation of liver enzymes to acute hepatitis (ALT>10 times of normal level). It indicates severe illness with high frequency of complication and mortality rates.