Jaundice in falciparum malaria; changing trends in clinical presentation--a need for awareness

To describe the clinical characteristics, laboratory parameters and prognostic factors in patients with falciparum malaria (FM) with jaundice.

A cross-sectional comparative study was conducted at the Department of Medicine, medical unit II, Jinnah Postgraduate Medical Centre, Karachi. Adult patients with jaundice and smear positive plasmodium falciparum infection, who fulfilled the inclusion criteria were selected for the study from amongst all cases of FM who presented during the study period. Patients were divided in to two groups on the basis of rising bilirubin and adverse outcome. The data was analyzed on SPSS ver 12. Results were expressed as, percentages, mean and standard deviations. P-value < 0.05 was taken as significant.

Among 76 patients of FM, 35 (46.05%) developed jaundice. Fifteen (42.86%) patients had bilirubin 3-10 mg/dl while 20 (57.14%) had bilirubin > 10 mg/dl. Comparative analysis of the groups showed that elevation of ALT and AST was modest in comparison with conjugated hyperbilirubinaemia while prolonged duration of illnes impaired consciousness, hepatomegaly, acute renal failure with deranged renal parameters, low platelet counts and high parasite density were significantly associated with rising bilirubin and adverse outcome. Twenty-one (60%) patients recovered completely while 14(40%) succumbed to the disease.

FM is one of the causes of severe jaundice in adults in this part of the world. This presentation of complicated FM needs to be recognized globally in order to institute prompt and specific therapy. Delayed diagnosis and inappropriate treatment is the leading cause of complications and increased mortality in FM.