Incidence, Severity, Prognostic Significance of Thrombocytopenia in Malaria

Abstract

The word "malaria" comes from the Italian, and means literally 'bad air'. Malaria remains today as it has been for centuries, a heavy burden on tropical communities, a threat to non-endemic countries, and a danger to travelers. Malaria ranks third among the major infectious diseases in causing death. Malaria is an infectious disease caused by plasmodium parasite. Plasmodium vivax, P. falciparum, P. ovale, P. malariae and P. knowlesi. 1 are the different species. P. falciparum account for majority of morbidity and is most lethal. 2 Populations living in sub-ABSTRACT Background: Malaria is an infectious disease caused by plasmodium parasite. P. falciparum account for majority of morbidity and mortality. Thrombocytopenia and anaemia are the most frequently associated hematological complications in malaria. The low platelet count together with acute febrile syndrome emerged as the strongest predictor of malaria a finding that is frequent and present even before anemia and splenomegaly sets in. Severe thrombocytopenia is a good predictor of poor prognosis than mild and moderate thrombocytopenia. The aim is to study the incidence, severity, prognostic significance of thrombocytopenia in malaria. Methods: This was an observational and prospective study. The study enrolled 100 patients with thrombocytopenia and fever who were proven to have malaria either by peripheral smear or Quantitative Buffy Coat (QBC) test or malarial antigen assay were included in the study and patients with thrombocytopenia due to other causes were excluded from the study. Platelet count was estimated on a fully automated quantitative analyzer. All the 100 patients were followed during the hospital stay and upto discharge or till the outcome. Results: The incidence of thrombocytopenia was 73% indicating a common association in malaria. Complicated malaria was observed in 58.80% of P. falciparum infection whereas 66% of P. vivax infection was associated with uncomplicated malaria. Severe thrombocytopenia showed positive correlation with severity of malaria. Thrombocytopenic patients with effective anti-malarial treatment showed 95.90% recovery and 3 patients 4.10% had mortality. Patients with severe thrombocytopenia were 8.5 times more likely to have complicated malaria with P <0.001 according to student "t" test. Conclusion: Thrombocytopenia is the most common hematological finding in malaria. Severe thrombocytopenia showed positive correlation with complicated malaria and a good predictor of poor prognosis. Patients with classical malarial fever and thrombocytopenia who were negative for malaria parasite were not included in the study.

A study of thrombocytopenia in malaria and its prognostic significance

“…21,23 These findings were comparable to the study conducted by Dharmesh Kumar N Patel et al, in which complicated malaria was more commonly caused by falciparum malaria and was rarely caused by other malarial parasites. 26 Kocher et al, Bezwada Srinivasa Rao et al,Sudheer Babu Devineni et al, they all observed that P. Falciparum infection was to be predominantly associated with complicated malaria and P.Vivax was more associated with uncomplicated malaria.…”

“…22 Later in 2015 Bezwada Srinivasa Rao et al also supported the present study with similar results showing 61% cases suffering from P.Vivax malaria, 35% cases had P. Falciparum malaria and 4% had mixed infection. 23 Present and above mentioned studies showed that P.Vivax malaria was more common among all malaria cases. Prevalence of P.Vivax malaria is common in India because of variations in climatic condition and breeding places of mosquito and genetic resistance of P. Falciparum.…”

A study of clinical profile and complication of malaria in a tertiary care centre in South-eastern region of Rajasthan, India

“…Present study was nearly similar to study done by Raoet BS al reported complicated malaria in 17 cases (18.89%) and uncomplicated malaria in 73 cases (81.11%). 26 In present and above study, uncomplicated cases were more than complicated cases because of P. Vivax species was common infection.…”

“…Later in 2015 Bezwada Raoet S al also supported the present study with similar results showing 61% cases suffering from P. Vivax malaria, 35% cases had P. Falciparum malaria and 4% had mixed infection. 23,26,28 In present study fever was the commonest clinical manifestation present in 100% cases followed by nausea vomiting in 52%, headache in 34%, myalgia in 28%, jaundice in 27%, diarrhoea in 20%, oliguria in 10%, pain abdomen in 07%, impaired consciousness in 04%, cough and breathlessness in 05% and joint pain in 5% cases. 23 Present study's results are nearly similar to study done by Gopinath VP et al reported fever in 97.8% and vomiting in 42.2%, headache in 69%, altered sensorium in 8.8% cases, Murthy GL et al who also reported fever with chills and rigor in 98.10%, altered sensorium in 48.10%, headache in 33.40%, diarrhoea in 18.35%, jaundice in 27.21% and oliguria in 6.96% cases, later Madhu Muddaiah et al noticed that fever was present in all cases (100%), nausea and vomiting in 37.36%, headache in 33.6%, jaundice in 15.78%, altered level of consciousness in 4.21% cases, and even Sudheer Babu Devineni et al also noted that fever was the most common symptom (100%) followed by vomiting in 22.22%, headache in 25.56%, jaundice in 15.56%, altered sensorium in 8.89%, pain abdomen in 7.77%, cough and breathlessness in 4.44%, and joint pain in 5.56%.…”

“…The present study is consistently similar to studies done by Maddhu et al had males 80.5% and females 19.5%, Preetam et al had males 75% and females 25%, Bezwada et al had males 76% and females 24%andG.VijayaKumaret al also noted males 76% and females 24% in their study. [23][24][25][26][27] This indicates that the incidence of malaria is more common in males than females this is because males are more frequently exposed to the risk of acquiring malaria than females because of their outdoor life which they lead. Further, female in India are usually better clothed than males, and hence they are less exposed.…”