Clinical Features of Children Hospitalized with Malaria- A study from Bikaner, Northwest India

Kochar DK, Tanwar GS, Khatri PC, Kochar SK, Sengar GS, Gupta A, Kochar A, Middha S, Acharya J, Saxena V, Pakalapati D, Garg S, Das A.

                A clinical prospective study was done on 303 admitted children with Malaria. Malaria is endemic in the tropics and subtropics, causing 247 million infections worldwide.  Peripheral blood smears (PBS), rapid diagnostic test (RDT), and polymerase chain reaction (PCR) test were done on admitted children to further analyze pathology. The proportions of patients infected with Plasmodium vivax were 33.99% or 102 patients out of the 303 being analyzed. The study was conducted at the Department of Pediatrics, Sadar Patel Medical College and Associated Group of Hospitals, Bikaner, Rajasthan, India from August 2007 to November 2008. The categorization criteria for children with severe Malaria were done according to the 2000 World Health Organization (WHO). Only patients with severe indices and evidence of the asexual phase of Malaria, or a positive RDT were used in this study (Kochar et. Al 2010).

            Thick and thin peripheral blood smears were used and stained with a Giesma stain and examined under oil immersion. The Rapid blood tests were based on the detection of the specific P. vivax antigen, Lactate dehydrogenase. Other tests such as complete blood count, palate count, bleeding count, clotting time, blood glucose, blood urea, serum creatine, serum bilirubin , serum aspartate aminotransferase, serum alanine aminotransferase, serum alkaline phosphate, complete urine analysis, and electrocardiogram to rule out co-infections such as typhoid fever, leptospirosis, infectious mononucleosis, and dengue fever. The PCR studies were ran against 18S ribosomal RNA gene template, a minimum of four rounds of PCR was done on each genome to eliminate overlooking co-infections (Kochar et al. 2010).

Cerebral Malaria was present in 13.9% of patients infected with severe P. vivax infections. Respiratory distress was present in 10 % of the patients infected with servere P. vivax infections. 26.2% of the patients severely infected with P. vivax suffered from Hepatic dysfunction, while 15.4% suffered from renal dysfunction. Abnormal bleeding was found in 10.8% of the patients infected with severe P.vivax. Hemoglobinuria was present in 3.1% of the patients infected with severe P.vivax. Multi-organ dysfunction was present in 47.7% of the patients infected with the severe P.vivax strain.  A total of 10 children died during the suration of the study, 60% of them died within 72 hours of the start of the study. The major causes of death for this study due to severe P. vivax infections were cerebral malaria and multi organ dysfunction (Kocher et al. 2010).

Kochar, DK, Tanwar, GS, Khatri, PC, Kochar , SK, Sengar, GS, Gupta, A, , et al. (2010). Clinical Features of Children Hospitalized with Malaria- A study from Bikaner, Northwest India. The American Journal of Tropical Medicine and Hygine , 83(5), 981-989.