Outcomes of paediatric malarial hepatopathy: a study from Eastern India

Abstract

Background Severe malaria causes multi-organ involvement ,
including hepatic dysfunction.Jaundice in severe malaria is found
more commonly in adults than in children. It is important to
assess the factors associated with malarial hepatopathy, the varied
clinical presentations, as well as the complications in order to
initiate early interventional measures. There are a limited number
of studies in the pediatric population on malarial hepatopathy.
Objective To assess the factors associated with malarial
hepatopathy, the varied clinical presentations, as well as its
complications.
Methods This prospective study was conducted in the Department
of Paediatrics, Sardar Vallabh Bhai Patel Post Graduate Institute of
Paediatrics (SVPPGIP), Cuttack, Odisha, India from January 20 10
to June 2013, and included 70 children with malaria and jaundice,
aged 6 months to 14 years. Malaria was confirmed by microscopic
examination of blood smears. Detailed clinical evaluations and
investigation s were carried out to find multi-organ afflictions,
with a special emphasis on hepatic involvement.
Results Of218 children with malaria admitted during this period,
70 (32%) children had fever and jaundice on presentation. All
children who had both Plasmodium faldparum and vivax infection
had malarial hepatopathy. Complications, including acute
kidney injury (AKI), disseminated intravascular coagulation
(DIC), cerebral malaria, and mortality, were significantly
higher among children with malarial hepatopathy compared to
children without hepatopathy. Howevei; there was no significant
difference of hypoglycemia, respiratory distress syndrome (RDS),
convulsions or severe anemia, between children with and without
hepatopathy.
Conclusion Hepatopathy is more common with mixed malaria
infections. The incidence of AKI, DIC, cerebral malaria, and
mortality are significantly higher in patients with hepatopathy.
Malarial hepatopathy should be considered in patients presenting
with acute febrile illness and jaundice so that specific treatment
can be initiated early to prevent increased morbidity and mortality.