Background and Objectives: Hepatic dysfunction is known to occur in Plasmodium falciparum malaria with varied incidence in different regions. Recent studies report liver involvement in P. vivax infection also. It is important to know about this entity in order to recognize it early and offer prompt and specific treatment. The present study aimed to assess the incidence, pattern, severity and outcome of hepatic dysfunction in cases of P. falciparum and P. vivax malaria admitted to a tertiary care hospital in northern India.
Materials and Methods: This retrospective study included all hospitalized patients diagnosed to have malaria from January 2013 to December 2013. Their clinical and biochemical parameters, complications and outcome were recorded.
Results: Of 115 patients included, 85(73.9%) had P. vivax infection and 30 (26.1%) had P. falciparum infection. The mean age was 36.7±16.1 years and male:female ratio was 2.7:1. Hepatic dysfunction was seen in 31.8%(27/85) patients of vivax malaria and 50%(15/30) patients of falciparum malaria (p=0.082). The mean bilirubin, AST and ALT in patients with hepatic dysfunction were 7.7 ±7.3 mg/dL, 97.1 ±103.3 IU/L and 72.3 ±87.8 IU/L respectively. Patients with falciparum malaria had significantly higher levels of mean bilirubin, AST, urea and creatinine. Patients with hepatic dysfunction had higher rate of complications like renal failure, shock, acute respiratory distress syndrome, and mortality.
Interpretation and conclusion: Hepatic dysfunction was more common and more severe in patients with P. falciparum malaria compared to P. vivax malaria. Patients with hepatic dysfunction had higher rates of complications and higher mortality.
WHO. World health report 2008. Geneva. World Health Organisation. 2008
Nadkar MY, Huchche AM, Singh R, Pazare AR. Clinical profile of severe P. vivax malaria in a tertiary care centre in Mumbai from June 2010-January 2011. J Assoc Physicians India. 2012;60: 11-3.
Barcus MJ, Basri H, Picarima H, Manyakori C, Sekartuti, Elyazar I, et al. Demographic risk factors for severe and fatal vivax and falciparum malaria among hospital admissions in north-eastern Indonesian Papua. Am J Trop Med Hyg. 2007;77:984-91.
Tjitra E, Anstey NM, Sugiarto P, Warikar N, Kenangalem E, Karyana M, et al. Multidrug-resistant Plasmodium vivax associated with severe and fatal malaria: a prospective study in Papua, Indonesia. PLoS Med. 2008;5:e128.
Bhalla A, Suri V, Singh V. Malarial hepatopathy. J Postgrad Med. 2006;52:315-20.
McMohan AE Jr, Kelsy JE, Deranf DE. Hepatitis of malarial origin: Clinical and pathologic study of fifty-four Korean veterans. AMA Arch Int Med. 1954;93:379-86.
Wali PN, Tandon HD. Malarial Hepatitis. J Indian Med Assoc. 1955;13:507:11.
Severe falciparum malaria. World Health Organization, Communicable Diseases Cluster. Trans R Soc Med Hyg. 2000;94:S1-90.
Devarbhavi H, Alvares JF, Kumar KS. Severe falciparum malaria simulating fulminant hepatic failure. Mayo Clin Proc. 2005;80:355-8.
Joshi YK, Tandon BN, Acharya SK, Babu S, Tandon M. Acute hepatic failure due to Plasmodium falciparum liver injury. Liver. 1986;6:357-60.
Saya RP, Debabrata G, Saya GK. Malarial Hepatopathy and Its Outcome in India. N Am J Med Sci. 2012; 4:449-52.
Anand AC, Puri P. Jaundice in malaria. J Gastroenterol Hepatol. 2005;20:1322-32.
Goljan J, Nahorski W, Felczak-Korzybska I, Gorski J, Myjak P. Liver injury in the course of malaria. Int Marit Health. 2000;51:30-9.
Hazra BR, Chowdhury RS, Saha SK, Ghosh MB, Mazumdar AK. Changing Scenario of malaria: A study at Calcutta. Indian J Malariol. 1998;35:111-6.
Echeverri M, Tobon A, Alvarez G, Carmona J, Blair S. Clinical and laboratory findings of Plasmodium vivax malaria in Colombia. Rev Inst Med Trop Sao Paulo. 2003;45:29-34.
Seth AK, Nijhawan VS, Bhandari MK, Dhaka RS. Malarial hepatitis: Incidence and liver morphology. Indian J Gastroenterol. 1997;16:A107.
Malhotra P, Malhotra N, Malhotra V, Chugh A, Chaturvedi A, Dahiya H, et al. Malarial Hepatopathy-Experience at Tertiary Care Centre of North India. The Indian Practitioner, [S.l.], p. 29-30, may. 2015. ISSN 2394-3017. Available at: . Date accessed: 31 Jul. 2015.
Wilairatana P, Looareesuwan S, Charoenlarp P. Liver profile changes and complications in jaundiced patients with falciparum malaria. Trop Med Parasitol. 1994;45:298-302.
Harris VK, Richard VS, Mathai E, Sitaram U, Kumar KV, Cherian AM et al. A study on clinical profile of falciparum malaria in a tertiary care hospital in south India. Indian J Malariol. 2001;38: 19-24.