Publication:

Complicated malaria: relationship of complications and parasite load to outcome

Background The incidence of complicated malaria cases is increasing day by day. Complicated malaria present in different ways in different places globally. If malaria is diagnosed and treated immediately, then the death rate is less than one percent. The objective was to study the relationship of complications and parasite load to outcome (mortality) among patients with complicated malaria.

Methods The present hospital based Prospective Observational study was carried out among 100 cases of “Complicated malaria.” The present study was carried out at Department of General medicine, Kamineni hospitals, L. B. Nagar, Hyderabad.

Results 71% patients were infected with Plasmodium falciparum, 25% with Plasmodium vivax and 4% with both Plasmodium falciparum and vivax. 12% patients deceased and 88% survived. The relationship between GCS, convulsions, pH, bicarbonate, lactate, hemoglobin, creatinine, SBP, PaO2/FiO2 ratio, PT, INR, aPTT, and outcome was statistically highly significant (p=0.000). The relationship between Total Bilirubin, RBS and outcome was statistically not significant (p=0.351). Multivariate analysis using logistic regression model, to determine the effect of studied variables on the final outcome, revealed no significant influence of studied variables in predicting the outcome (p>0.05). The relationship between increasing parasite load and outcome was studied, and it showed it was statistically highly significant (p=0.000).

Conclusions The prognosis and outcome of patients with complicated malaria worsen as the parasite load increases and the probability of death increases markedly in such patients. The presentation of inappropriate parameters at admission, aid us in predicting poor outcome and appropriate treatment plan.