Jaundice in falciparum malaria--some prospective observations

The present prospective study of slide positive Plasmodium falciparum patients revealed a higher (17%) incidence of jaundice. This is much higher than reported earlier. Serum transaminases were raised by two to three times the normal value. Histologically the most conspicuous finding was reticulo-endothelial cell proliferation in the liver along with mononuclear cell infiltration. Malarial parasites were not found in the biopsy specimens. Mortality was high especially amongst the late presenters. In areas endemic for malaria, awareness of this entity is important. In a patient with fever and jaundice with or without altered sensorium, disproportionate hyperbilirubinaemia but with only mild elevation of liver enzymes could help differentiate these cases from viral hepatitis. The diagnosis can be confirmed by peripheral blood examination, done if required. As the mortality in late presenters is high, early diagnosis in such cases with institution of specific therapy may be life saving.