DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20180552

Hepatic dysfunction in children with complicated malaria

Alexander Mannu, Sunil Kumar Agarwalla, Jaishree Vasudevan, Kathir Subramaniam T., Ahamed Basha A.

Abstract


Background: Complicated malaria caused by Plasmodium falciparum alone or with P. vivax can lead to multi organ dysfunction. There is a paucity of studies about hepatic dysfunction in children with complicated malaria. Hence, this retrospective study was done to find out the clinico-biochemical profile of children with complicated malarial hepatic dysfunction from a malaria endemic region of India. Further, liver function test (LFT) response to Artemisinin-based combination therapy (ACT) i.e. artesunate + sulfadoxine-pyrimethamine therapy in the malarial hepatic dysfunction children was assessed.

Methods: Out of 203 children confirmed to have malaria, 60 children were found to have complicated malaria with jaundice as per WHO malaria guidelines (total serum bilirubin >3 mg%). Physical examination, malaria related biochemical and ultra-sonographic findings were noted. All the children were found to be uniformly on ACT as per institute protocol adapted from WHO guidelines. Biochemical parameters of hepatic function were compared between day 1 and 4.

Results: Presentations were fever, pallor and clinical jaundice in 100%, reddish urine in 63.3%, tender hepatomegaly in 100% and splenomegaly in 81.7% of the study population. Liver function test showed mild to moderate elevation of serum bilirubin and enzymes with remarkable recovery noticed with the use of ACT in all the study subjects.

Conclusions: Clinical presentations of malarial hepatic dysfunction although mimics viral hepatitis, LFT showed mild to moderate elevation only. Further, ACT therapy was found effective in the management of all children with hepatic dysfunction in complicated malaria.


Keywords


ACT, Children, Complicated malaria, LFT, Hepatic dysfunction

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References


Sheet WF. World Malaria Report 2015. Back to cited text. 2016;(1):87-92.

Abro AH, Ustadi AM, Abro HA, Abdou AS, Younis NJ, Akaila SI. Jaundice with hepatic dysfunction in P. falciparum malaria. J Coll Physicians Surg Pak. 2009;19(6):363-6.

Pradhan SK, Mutalik P, Tandi D, Das L, Satpathy SK. Spectrum of clinical and biochemical profile in children with malarial nephropathy. Pediatr Oncall J. 2014;11(4):12e17.

Schumacher RF, Spinelli E. Malaria in children. Mediterranean J Hematol Infect Dis. 2012;4(1).

Bhalla A, Suri V, Singh V. Malarial hepatopathy. J Postgrad Med. 2006;52(4):315.

Devarbhavi H, Alvares JF, Kumar KS. Severe falciparum malaria simulating fulminant hepatic failure. Mayo Clinic Proceedings. Elsevier; 2005:355-8.

Shah S, Ali L, Sattar RA, Aziz T, Ansari T, Ara J. Malarial hepatopathy in falciparum malaria. J Coll Physicians Surg Pak. 2009;19(6):367-70.

Satpathy S, Mohanty N, Nanda P, Samal G. Severe falciparum malaria. Indian J Pediatr. 2004;71(2):133-5.

Mohanty N, Satpathy S, Nanda P. Hepatopathy in complicated falciparum malaria: report from eastern India. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2004;98(12):753-4.

Fazil A, Vernekar PV, Geriani D, Pant S, Senthilkumaran S, Anwar N, et al. Clinical profile and complication of malaria hepatopathy. J Infect Pub Health. 2013;6(5):383-8.

Anand AC, Puri P. Jaundice in malaria. J Gastroenterol Hepatol. 2005;20(9):1322-32.

Malloy HT, Evelyn KA. The determination of bilirubin with the photoelectric colorimeter. J Biol Chem. 1937;119(2):481-90.

Reitman S, Frankel S. A colorimetric method for the determination of serum glutamic oxalacetic and glutamic pyruvic transaminases. Am J Clin Pathol. 1957;28(1):56-63.

Hazra BR, Chowdhury RS, Saha SK, Ghosh MB, Mazumder AK. Changing scenario of malaria: a study at Calcutta. Indian J Malariol. 1998;35(2):111-6.

Mockenhaupt FP, Ehrhardt S, Burkhardt J, Bosomtwe SY, Laryea S, Anemana SD, et al. Manifestation and outcome of severe malaria in children in northern Ghana. Am J Tropical Med Hygiene. 2004;71(2):167-72.

World Health Organization. Communicable diseases cluster: plan of action 2000-2001: end-biennium status; 2001. Available at http://apps.who.int/iris/bitstream/10665/67393/1/WHO_CDS_2002.13.pdf

Viriyavejakul P, Khachonsaksumet V, Punsawad C. Liver changes in severe Plasmodium falciparum malaria: histopathology, apoptosis and nuclear factor kappa B expression. Malaria J. 2014;13(1):106.

Das B. Renal failure in malaria. J Vector Borne Diseases. 2008;45(2):83.

Menendez C, Fleming A, Alonso P. Malaria-related anaemia. Parasitology Today. 2000;16(11):469-76.

Zijlmans WC, Van Kempen AA, Ackermans MT, De Metz J, Kager PA, Sauerwein HP. Very young children with uncomplicated falciparum malaria have higher risk of hypoglycaemia: a study from Suriname. Tropical Med Int Health. 2008;13(5):626-34.

Zha Y, Zhou M, Hari A, Jacobsen B, Mitragotri N, Rivas B, et al. Ultrasound diagnosis of malaria: examination of the spleen, liver, and optic nerve sheath diameter. World J Emerg Med. 2015;6(1):10.

WHO. Severe malaria. Tropical Med Int Health. 2014;19(1):7-131.