A study of clinical and biochemical features in severe and complicated malaria in fections in Sri Lanka

Abstract

144 malaria patients admitted to the General Hospitals of Colombo and Anuradhapura and Lady Ridgeway Chidren's Hospital were assessed to detect and study severe and complicated infections. Malaria was diagnosed by microscopy and on clinical grounds. Severe and complicated infections were defined on accepted criteria and a numerical scoring methods. 22 patients with severe and complicated malaria were detected during 6 months from May 1994, comprising below 12 years and 16 adults. 19 had P.falciparum infection and 3 had P. vivax. Multi-system involvement was seen in 6. The clinical syndromes seen in these 22 patients were, cerebral symptoms and signs in 9, severe anaemia in 10, severe jaundice with or without liver failure in 5, pulmonary ,oedema in I, renal failure in 3, shock in I and bleeding diatheses in 2 patients. The serum creatinine phosphokinase (CPK) and aldolase (ALD) concentrations were significantly higher (p=0.016 and 0.001 respectively) in patients with severe and complicated malaria (mean = 214.25 and 10.7 respectively) than in those with uncomplicated malaria (mean = 97.3 and 4.6 respectively). Among those with severe and complicated malaria, patients with cerebral involvement had significantly higher concentrations of serum CPK and aldolase (p= 0.015 and 0.026 respectively) )mean= 428 and 20.1) than those without cerebral involvement (mean = 89.5 and 4.46) Thus concentrations of serum aldolase and CPK levels appear to be markers of cerebral malaria and possibly the general severity of disease in malaria. These findings have implications on the pathogenesis of severe malaria.