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Clinico-laboratorical spectrum of malaria in children: Emerging new trends

Background: Malaria is an endemic in developing countries across the world and is associated with significant morbidity and mortality. Recently, a significant change in clinical presentation and various laboratory parameters has been reported worldwide. Objective: To evaluate the clinical and laboratory parameters in children with malaria. Material and methods: This prospective study evaluated 55 children aged 1-17 years admitted at SPMCHI, SMS Medical College Jaipur from July 2013 to October 2014 having malaria. A detailed clinical history, examination and relevant laboratory investigations were recorded on day of presentation. Results: In severe malaria, Plasmodium vivax was the predominant organism in 60.4% cases whereas Plasmodium falciparum was present in 16.3% cases. Mixed infection was seen in 23.3% cases. In uncomplicated malaria, Plasmodium vivax was observed in 50% cases whereas Plasmodium falciparum and mixed infection was seen in 33.4% and 16.6% cases, respectively. Most common clinical presentation was fever (94.5%) followed by splenohepatomegaly (70.9%), pallor (69%) and jaundice (25.4%). Most common complication was prostration (49%) followed abnormal bleeding (30.9%) ,severe anemia (27.3%), renal impairments (20%), shock (16.3%), altered sensorium (16.3%), convulsion (12.7%) and pulmonary edema (12.7%). Among laboratory parameters, thrombocytopenia was observed in 70.9% and deranged hepatic functions were observed in 25.4% children. Conclusion: In changing clinical spectrum of malaria, Plasmodium vivax is predominantly associated with severe malaria. Presence of thrombocytopenia, severe anemia, bleeding tendencies in a patient of acute febrile illness should alert the clinician the possibility of malaria.

Author(s): Hari Mohan Meena, B S Sharma, M L Gupta, Abhishek Sharma, Ramesh Choudhary, Prity Sharma