Kochar D K, Kochar S K, Agrawal R P, Sabir M, Nayak K C, Agrawal T D, Purohit V P, Gupta R P
Department of Medicine, S.P. Medical College, Bikaner, India.
J Vector Borne Dis. 2006 Sep;43(3):104-8.
BACKGROUND & OBJECTIVES: Recently there were reports from all over India about changing spectrum of clinical presentation of severe malaria. The present study was planned to study the same in the northwest India.
This prospective study was conducted on patients of severe malaria admitted in a classified malaria ward of a tertiary care hospital in Bikaner, Rajasthan (northwest India) during 1994 and 2001. It included adult patients of both sexes belonging to all age groups. The diagnosis of Plasmodium falciparum was confirmed by demonstrating asexual form of parasites in peripheral blood smear. All patients were treated with i.v./oral quinine. The specific complications were treated by standard WHO protocol. The data for individual complications for both the years were analysed by applying chi-square test.
In a prospective study in 1994 the spectrum of complication was dominated by cerebral malaria (25.75%) followed by jaundice (11.47%), bleeding tendencies (9.59%), severe anaemia (5.83%), shock (5.26%), Acute respiratory distress syndrome-ARDS (3.01%), renal failure (2.07%) and hypoglycemia (2.07%) whereas in 2001 it was dominated by jaundice (58.85%) followed by severe anaemia (26.04%), bleeding tendencies (25.52%), shock (10.94%), cerebral malaria (10.94%), renal failure (6.25%), ARDS (2.08%) and hypoglycemia (1.56%). The sharp difference for presence of jaundice and severe anaemia in 2001 and cerebral malaria in 1994 was statistically significant. Similarly, the important cause of mortality in 2001 was multiple organ dysfunction syndrome (71.10%) with predominant presentation of jaundice and renal failure, whereas in 1994, it was cerebral malaria (77.96%).
INTERPRETATION & CONCLUSION: The observation of changing spectrum of severe malaria in this study and a significant increase in presentation with jaundice as an important manifestation is highly essential for primary, secondary and tertiary level health care providers for proper diagnosis and management.
近期，印度各地均有关于重症疟疾临床表现谱变化的报道。本研究旨在对印度西北部地区的这一情况进行研究。
本前瞻性研究针对1994年至2001年期间在印度西北部拉贾斯坦邦比卡内尔一家三级护理医院的分类疟疾病房收治的重症疟疾患者开展。研究对象包括所有年龄组的成年男女患者。通过在外周血涂片中发现疟原虫的无性体来确诊恶性疟原虫感染。所有患者均接受静脉注射/口服奎宁治疗。特定并发症按照世界卫生组织的标准方案进行治疗。对这两年中每种并发症的数据应用卡方检验进行分析。
在1994年的一项前瞻性研究中，并发症谱以脑型疟疾为主（25.75%），其次是黄疸（11.47%）、出血倾向（9.59%）、严重贫血（5.83%）、休克（5.26%）、急性呼吸窘迫综合征（ARDS，3.01%）、肾衰竭（2.07%）和低血糖（2.07%）；而在2001年，以黄疸为主（58.85%），其次是严重贫血（憨26.04%）、出血倾向（25.52%）、休克（10.94%）、脑型疟疾（10.94%）、肾衰竭（6.25%）、ARDS（2.08%）和低血糖（1.56%）。2001年黄疸和严重贫血的出现情况与1994年脑型疟疾的出现情况之间的显著差异具有统计学意义。同样，2001年的主要死亡原因是多器官功能障碍综合征（71.10%），主要表现为黄疸和肾衰竭，而在1994年，主要死亡原因是脑型疟疾（77.96%）。
本研究中关于重症疟疾临床表现谱变化的观察结果以及黄疸作为重要表现的显著增加，对于初级、二级和三级医疗保健提供者进行正确诊断和管理至关重要。
