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Related Experiment Videos

Malarial hepatitis: a heterogeneous syndrome?

A C Anand1, C Ramji, A S Narula

  • 1Command Hospital and Pathology Laboratory (Eastern Command) Calcutta, West Bengal, India.

The National Medical Journal of India
|March 1, 1992
PubMed
Summary
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Malarial hepatitis, a complication of Plasmodium falciparum malaria, presents as a heterogeneous syndrome. This study identified 18 cases, revealing distinct severe and mild clinical subsets.

Area of Science:

  • Infectious Diseases
  • Hepatology
  • Tropical Medicine

Background:

  • The clinical spectrum and incidence of malarial hepatitis in Plasmodium falciparum infected patients with jaundice remain unclear.
  • It is debated whether malarial hepatitis is a singular entity or a collection of diverse conditions.

Purpose of the Study:

  • To prospectively investigate the natural history of malarial hepatitis in patients with falciparum malaria and jaundice.
  • To differentiate malarial hepatitis from other causes of hepatitis in endemic regions.

Main Methods:

  • Prospective study of patients with falciparum malaria and jaundice admitted to military hospitals in Northeast India (1988-1991).
  • Exclusion of drug-induced or viral hepatitis through clinical history, serological tests, and liver histology.

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  • Monitoring of liver function tests, including serum glutamate pyruvate transaminase (SGPT).

    • Main Results:

    • Malarial hepatitis was identified in 18 of 39 (46%) patients with falciparum malaria and jaundice, characterized by SGPT levels >3x upper limit of normal.
    • Two clinical presentations were observed: a severe group (13 patients) with coma and renal failure, and a milder group (5 patients).
    • Liver histology showed Kupffer cell hyperplasia and pigment deposition; 4 severe cases were fatal.

    Conclusions:

    • Malarial hepatitis is a heterogeneous syndrome occurring in a subset of falciparum malaria patients with jaundice.
    • The severe form of malarial hepatitis, though serious, responds better to therapy than fulminant hepatic failure.
    • Distinguishing malarial hepatitis is crucial for appropriate patient management and treatment strategies.