Sharma S K, Manandhar D N, Khanal B, Dhakal S, Kalra S, Das M L, Karki P
Department of Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal.
Nepal Med Coll J. 2011 Jun;13(2):123-7.
Malaria is endemic in Nepal. Its poor outcome is associated with acute renal failure (ARF), hepatopathy and cerebral malaria. The clinical profiles, biochemical parameters and outcome of 25 patients of falciparum malaria diagnosed either by optimal test, peripheral blood smear (PBS) or Quantitative buffy coat (QBC) admitted in BP Koirala Institute of Health Sciences were studied. Majority of patients (84%) was from the age group 15-45 years. Mean age was 33 +/- 16 years. There were 16 males and 9 females. All had history of fever. Twenty patients were optimal positive, 9 positive in PBS and 12 were QBC positive for Plasmodium falciparum. Mean duration of fever was 13 +/- 9 days. Patients with renal or hepatic involvement presented earlier. Renal dysfunction (S. creatinine > 1.5 mg/dl) was present in 60%. Ten patients had ARF (S. creatinine > 3 mg/dl); five out of them were oliguric/anuric. S. creatinine in patients without renal dysfunction, with renal dysfunction but without renal replacement therapy (RRT) and who underwent RRT were 1.1 +/- 0.24, 3.98 +/- 1.9 and 4.53 +/- 1.72 mg/dL respectively. Serum creatinine of patients with and without hepatic dysfunction respectively were 3.26 +/- 1.98 and 1.26 +/- 0.48 mg/dL (p = 0.001 (CI 0.9-3.10)). Total bilirubin of > 2.5 mg/dl was present in 77%. Total bilirubin of patients with renal dysfunction who underwent and who did not undergo RRT were 10.3 vs. 3.76 mg/dL (p = 0.024 (CI 1.07-12.0)). Fourteen patients had cerebral malaria. Eight patients underwent RRT (hemodialysis or peritoneal dialysis). Six patients died. Five died within 48 hrs of presentation. Patients who had renal and/or hepatic dysfunction had increased morbidity and mortality.
疟疾在尼泊尔呈地方性流行。其不良预后与急性肾衰竭（ARF）、肝病和脑型疟疾有关。对在BP柯伊拉腊健康科学研究所收治的25例经最佳检测、外周血涂片（PBS）或定量血沉棕黄层（QBC）诊断为恶性疟原虫疟疾的患者的临床特征、生化参数及预后进行了研究。大多数患者（84%）年龄在15至45岁之间。平均年龄为33±16岁。男性16例，女性9例。所有患者均有发热史。20例患者最佳检测呈阳性，9例PBS检测呈阳性，12例QBC检测恶性疟原虫呈阳性。平均发热持续时间为13±9天。有肾脏或肝脏受累的患者发病较早。60%的患者存在肾功能不全（血清肌酐>1.5mg/dl）。10例患者出现急性肾衰竭（血清肌酐>3mg/dl）；其中5例为少尿/无尿。无肾功能不全、有肾功能不全但未接受肾脏替代治疗（RRT）以及接受RRT的患者血清肌酐分别为1.1±0.24、3.98±1.9和4.53±1.72mg/dL。有肝功能不全和无肝功能不全患者的血清肌酐分别为3.26±1.98和1.26±0.48mg/dL（p = 0.001（CI 0.9 - 3.10））。77%的患者总胆红素>2.5mg/dl。接受RRT和未接受RRT的肾功能不全患者总胆红素分别为10.3和3.76mg/dL（p = 0.024（CI 1.07 - 12.0））。14例患者出现脑型疟疾。8例患者接受了RRT（血液透析或腹膜透析）。6例患者死亡。5例在就诊后48小时内死亡。有肾脏和/或肝脏功能不全的患者发病率和死亡率增加。
