A study of various complications and outcome of falciparum malaria in patients of a rural South Indian medical college hospital

Abstract

Background: Sparse published data are available regarding clinical presentation and complications of falciparum malaria from Andhra Pradesh state. Methods: In this prospective, observational study conducted during the period November 2012 to June 2014 at our teaching hospital in Kuppam, Andhra Pradesh, adult patients (n=96) admitted with fever confirmed to be suffering from falciparum malaria based on peripheral blood smear examination and / or malaria antigen test positive by rapid diagnostic test were studied. The clinical presentation and various complications of falciparum malaria were documented. Results: The male to female ratio was 2:1. Majority of the patients (70%) were in the age group 26-60 years. Fever was present in all cases. Splenomegaly (66%) was the most common physical sign followed by pallor (31%) and icterus (22%). Anaemia (51%), was the most common complication, followed by cerebral malaria (33.3%), acute respiratory distress syndrome (ARDS) (32.3%), acute kidney injury (AKI) (29.2%), and jaundice (25%). Majority of the patients presented with multiple complications (73%) than single complication (27%). Artemesinin-based combination therapy was administered to 72 of the 96 patients of whom 43 patients recovered. Quinine therapy was given to 14 patients of whom 10 recovered. Quinine plus ACT combination therapy was given to 10 patients and 7 recovered. seven of the 96 patients died; and 29 out of 96 patients were taken home against medical advice. Overall 36/96 (37.5%) patients had a poor outcome. All 7 patients who expired had multiple complications. Mortality was higher in patients who had co-existent AKI, hypotension and cerebral malaria. Conclusion: Early identification of high risk cases and institution of prompt treatment can reduce the mortality rate in falciparum malaria.