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Published on: January 3, 2012
Severe falciparum malaria simulating fulminant hepatic failure.
Harshad Devarbhavi1, Jose Filipe Alvares, K Shiva Kumar
1Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India. d_harshad@vsnl.net
Mayo Clinic Proceedings
|March 11, 2005
Summary
Severe malaria can mimic fulminant hepatic failure (FHF). Differentiating requires recognizing key clinical signs like hepatomegaly and normal prothrombin time, crucial for timely diagnosis in endemic regions.
Area of Science:
- Infectious Diseases
- Hepatology
- Clinical Medicine
Background:
- Fulminant hepatic failure (FHF) presents a diagnostic challenge, particularly in malaria-endemic areas.
- Malarial hepatitis can clinically resemble viral FHF, necessitating careful differentiation.
Purpose of the Study:
- To delineate the clinical and laboratory distinctions between malarial hepatitis simulating FHF (MHsFHF) and viral FHF.
- To aid in the differential diagnosis of FHF in regions where malaria is prevalent.
Main Methods:
- A comparative study involving 25 patients with MHsFHF and 25 patients with viral FHF.
- Analysis of clinical features (jaundice duration, consciousness alteration, organomegaly) and laboratory parameters (hemoglobin, leukocyte count, platelet count, transaminases, urea nitrogen, prothrombin time).
Main Results:
- Hepatomegaly and splenomegaly were significantly more common in MHsFHF (72% and 48%) compared to viral FHF (12% and 0%).
- MHsFHF patients exhibited lower hemoglobin, leukocyte, and platelet counts, and lower transaminase levels than viral FHF patients.
- Thrombocytopenia and elevated serum urea nitrogen were universal in MHsFHF; normal prothrombin time was observed in MHsFHF but abnormal in all viral FHF cases.
- Mortality was lower in MHsFHF (24%) than in viral FHF (76%).
Conclusions:
- In malaria-endemic areas, severe malaria should be a key consideration in the differential diagnosis of FHF.
- The presence of hepatomegaly and a normal prothrombin time in a patient with FHF strongly suggests malaria.
- Peripheral blood smear examination is essential for confirming malaria in suspected FHF cases.
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