Study of clinical profile of falciparum malaria in a tertiary referral centre in Central India.

BACKGROUND AND OBJECTIVE Malaria, a disease with protean manifestations is endemic in India with an estimated 70-100 million cases each year. Of these 45-50% are plasmodium falciparum. The present study is aimed at to study clinical features, complications, response to treatment and outcome in a tertiary care hospital. METHODOLOGY This hospital based cross sectional study was done on 80 confirmed cases of falciparum malaria (either by peripheral smear or rapid diagnostic test) more than 12 years of age admitted in NKPSIMS and LMH from December 2009 to December 2010.A case sheet proforma was prepared and data (demographic profile, clinical feature, investigation, treatment, and complication) from all indoor patients was collected and analyzed. RESULT Out of 80 patients, 60 (75%) were males and 20 (25%) were females. Most of the patients were between the age group 21-40 years with the highest incidence between the age group of 21-30. The numbers of admissions due to malaria increased from June onward with maximum number of cases were found in the month of September. Fever was the most common symptom followed by impaired consciousness. Anemia was present in 52 (65%) patients, out of which 5 (6.25%) patients had severe anemia. Thrombocytopenia was present in 46 (57.5%) patients. Abnormal liver function tests were observed in 28 (35%) subjects while abnormal kidney function tests were observed in 26 (32.5%) patients. As per WHO definition of severe falciparum malaria, 37 patients suffered from severe falciparum malaria (46.25%) in the form of impaired consciousness or unarousable coma, clinical jaundice plus evidence of other organ dysfunction, severe renal impairment, severe anemia, circulatory collapse and ARDS. Maximum number, 62 (77%) patients received the combination of artesunate and clindamycin. This also showed that the combination of artesunate and clindamycin in severe Plasmodium falciparum malaria is a very good therapeutic option. Apart from being effective in seriously ill patients it is quite safe also. Mortality rate was 6.25%.Cause of death was acute renal failure with metabolic acidosis, aspiration pneumonia secondary to seizure, cerebral malaria and circulatory shock. CONCLUSION Early diagnosis, anticipation of complications, close monitoring of vital parameters and combination therapy to overcome drug resistance perhaps helped to curtail the extent of mortality in this study.