|Year : 2014 | Volume
| Issue : 2 | Page : 76-80
Socio-demographic characters, clinical profile and laboratory parameters in malaria cases due Plasmodium falciparum and Plasmodium vivax: A comparative study
Vinayak V Shelat1, Harshal T Pandve1, Gayatri Pathak2
1 Department of Community Medicine, Smt. Kashibai Navale Medical College, Narhe, Pune, Maharashtra, India
2 Department of Pathology, Smt. Kashibai Navale Medical College, Narhe, Pune, Maharashtra, India
|Date of Web Publication||18-Aug-2014|
Dr. Harshal T Pandve
Department of Community Medicine, Smt. Kashibai Navale Medical College, Narhe, Pune - 411 041, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: As per recent research patients with severe Plasmodium falciparum and Plasmodium vivax develop similar disease manifestations.
Objectives: To compare the sociodemographic characters, clinical profile, and laboratory parameters of cases of malaria due to P. falciparum and P. vivax species.
Methodology: Study design: Record-based retrospective study; study settings: Hospital based; study subjects: Records of malaria patients admitted to a tertiary care teaching hospital during 2009-2010. The malaria patients were categorized as P. falciparum and P. vivax malaria cases. The sociodemographic factors, clinical profile, and laboratory parameters of P. falciparum and P. vivax malaria cases was evaluated. Statistical analysis: Percentages, proportion, and χ2 test.
Results: A total of 111 malaria patients' records were studied. Twenty-five (22.52%) cases were due to P. falciparum and 86 (74.48%) cases were due to P. vivax. There was no difference observed in sociodemographic characters of P. falciparum and P. vivax malaria cases. Most of the common symptoms were similar in P. falciparum and P. vivax malaria cases. Splenomegaly was common in P. vivax cases, while hepatomegaly was common in P. falciparum cases. 18 (72%) P. falciparum cases and 50 (58.14%) P. vivax cases had thrombocytopenia. Severe anemia was present only in P. falciparum cases. Among other laboratory parameters, there was not much difference observed.
Conclusion: There was not much difference in sociodemographic characters, clinical profile, and laboratory parameters of P. falciparum malaria or P. vivax malaria.
Keywords: Clinical profile, comparison, laboratory parameters, P. falciparum, P. vivax, socio-demographic characters
|How to cite this article:|
Shelat VV, Pandve HT, Pathak G. Socio-demographic characters, clinical profile and laboratory parameters in malaria cases due Plasmodium falciparum and Plasmodium vivax: A comparative study. J Med Trop 2014;16:76-80
|How to cite this URL:|
Shelat VV, Pandve HT, Pathak G. Socio-demographic characters, clinical profile and laboratory parameters in malaria cases due Plasmodium falciparum and Plasmodium vivax: A comparative study. J Med Trop [serial online] 2014 [cited 2021 May 10];16:76-80. Available from: https://www.jmedtropics.org/text.asp?2014/16/2/76/139056
| Introduction|| |
Malaria is a potentially life-threatening parasitic disease caused by parasites known as Plasmodium vivax, Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale. There are two types of parasites of human malaria, P. vivax, P. falciparum, which are commonly reported from India. Malaria is a public health problem in several parts of the country. About 95% population in the country resides in malaria endemic areas and 80% of malaria reported in the country is confined to areas consisting 20% of population residing in tribal, hilly, difficult, and inaccessible areas. 
As per World Health Organisation report 2011-2012, South East Asian region bears the second largest burden of malaria (13%), only being next to African region (81%). Among South East Asia region, India shares two-thirds of the burden (66%) followed by Myanmar (18%) and Indonesia (10%). In India, the most common and deadliest species is P. falciparum contributing to 52% of the total malaria cases in 2010 which is closely followed by P. vivax. Other two species are P. malariae and P. ovale which contribute to <10% of the burden with very few cases being due to ovale species. Recently, a fifth Plasmodium species, Plasmodium knowlesi which usually infects macaques has been identified and over the past few years hundreds of human cases have been reported in South and Southeast Asian countries, especially Malaysia with increasing numbers in Europe as well. 
The high mortality rate from P. falciparum is due to its ability to induce severe malaria, and in some cases, multiple organ dysfunction. The presenting symptoms and mortality patterns of severe malaria vary widely according to the geographical setting and therefore transmission intensity. Though P. vivax was considered a benign parasite compared with P. falciparum, recent research indicates patients with severe P. falciparum and P. vivax develop similar disease manifestations. 
It is important to study various factors in malaria cases due to P. falciparum and P. vivax in details. This study was carried out with following objectives:
- To study some socio-demographic factors of cases of malaria due to P. falciparum and P. vivax species
- To study the clinical profile of cases of malaria due to P. falciparum and P. vivax species
- To study and compare the laboratory parameters of cases of malaria to P. falciparum and P. vivax species.
| Methodology|| |
Record-based retrospective study was carried out at tertiary care teaching hospital in Pune city of Maharashtra. Two years of data of all confirmed cases of malaria who were admitted in the hospital was collected from the Medical Records Department of the Hospital. Selected sociodemographic details such as age, and gender, and area of residence were taken from records. All important clinical findings mentioned in the case sheet were taken in details. All important laboratory parameters were also taken in details. The malaria cases were categorized as malaria due to P. falciparum and P. vivax. The sociodemographic characters, clinical profile (important symptoms and signs), any complications mentioned and important laboratory parameters (hemoglobin percentages, total leucocyte count, platelet count, and serum bilirubin and serum creatinine) were compared among two categories mentioned above.
Percentages, proportion were calculated. χ2 was used as test of significance.
The study was approved by the Institutional Ethics Committee.
| Results|| |
A total of 111 malaria cases were included in the study, out of those 25 (22.52%) cases were due to P. falciparum and 86 (74.48%) cases were due to P. vivax.
Seventy-three (65.77%) malaria cases were males and 38 (34.23%) were females. Majority 34 (30.63%) of the malaria cases were from 21 to 30 years of age group followed by 11-20 years age group (22.52%).
Fifty-five (49.54%) malaria cases were from urban area and 56 (50.46%) were from rural areas.
Majority of the malaria cases were admitted during south-west monsoon season 55 (49.54%) followed by 33 (29.73%) were admitted during post-monsoon season.
Fifty-one (45.95%) malaria cases had hospitalization duration of <5 days. 49 (44.14%) malaria cases had hospitalization duration of 5-10 days, while 11 (9.91%) malaria cases had hospitalization of more than 10 days. There was no mortality reported due to malaria in this study.
In the above mentioned sociodemographic characteristics, no statistically significant difference was observed among malaria cases due to P. falciparum and P. vivax [Table 1].
|Table 1: Comparison of some important factors in P. falciparum and P. vivax malaria|
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Similarly, no difference was also observed in the total duration of hospitalization due to P. falciparum malaria and P. vivax malaria [Table 1].
The most common symptom was fever (96.34%) followed by chills 96 (86.47%). Twenty-seven (24.32%) of the malaria cases had body ache, while 26 (23.42%) had headache and 25 (22.52%) had vomiting. Other features observed were nausea, dry cough, anorexia, and giddiness.
Comparison of occurrence of symptoms in malaria cases due to P. falciparum and P. vivax showed that all 25 P. falciparum cases had fever while 82 (95.35%) P. vivax had fever. 22 (88%) P. falciparum cases had chills, similarly 74 (86.05%) P. vivax cases had chills [Table 2].
|Table 2: Comparison of occurrence of symptoms in P. falciparum and P. vivax malaria|
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Among the important clinical signs pallor was present in 75 (67.57%) malaria cases followed by splenomegaly in 31 (27.92%) cases and hepatomegaly in 24 (21.62%) cases. Convulsions were reported in 2 patients, both were with P. falciparum malaria.
Splenomegaly was common in P. vivax cases, while hepatomegaly was common in P. falciparum cases [Table 3].
|Table 3: Comparison of occurrence of signs in P. falciparum and P. vivax malaria|
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Thrombocytopenia was the most common complication in malaria cases as it was observed 68 (61.26%) cases. 18 (72%) P. falciparum cases had thrombocytopenia while 50 (58.14%) P. vivax cases had thrombocytopenia. Severe anemia was present in 2 case, both were due to P. falciparum. Similarly, cerebral malaria was seen in 3 patients all were due to P. falciparum. 3 cases had renal failure; all were in P. vivax malaria.
In comparison of laboratory parameters of P. falciparum and P. vivax cases, severe anemia (less than 5 g%) was present only in P. falciparum cases. In other laboratory parameters, there was not much difference observed [Table 4].
|Table 4: Comparison of laboratory parameters in P. falciparum and P. vivax malaria|
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| Discussion|| |
In this study, we retrospectively studied the sociodemographic characteristics, clinical, as well as the laboratory findings of 111 diagnosed patients of malaria and compared those in P. falciparum and P. vivax cases. 25 (22.52%) cases were of P. falciparum and 86 (77.48%) were P. vivax. This finding is similar to the findings of the study conducted by Muddaiah and Prakash.  In this study, the male:female ratio was 2:1. This finding is similar to that of the study conducted by Muddaiah and Prakash as well as study conducted at Ratnagiri district by Gauravi Mishra. , High infectivity in the male population has been attributed to high mobility and easy access to medical aid. Furthermore, males are more exposed to the risk of acquiring malaria due to more outdoor activities. Cases of malaria were studied with respect to the seasonal variation. Maximum incidence (61%) was noted during the south-west monsoon season from June to September. Similar observation were noted in the study other studies. , This association of increased malaria incidence with rain fall can be due to both, increase in breeding sites and increased survival rates of female anopheles because of rise in relative humidity.
In this study, there was no difference was found in sociodemographic characteristic, seasonal variation as well as hospitalization duration when we compared P. facliparum cases with P. vivax cases.
Among all the patients, fever and chills were the most common presenting symptoms followed by body ache, headache, and vomiting. Fever was present in all cases of P. falciparum. This finding is similar to the finding of other studies. , Pallor (69%) was the most common presenting sign followed by splenomegaly (27%) and hepatomegaly (22%) Splenomegaly was more common in cases with vivax infection (33% of vivax cases); one of the postulated reasons for this could be due to high incidence of relapses and chronic infection in P. vivax infection. 69% patients in our study had pallor which is comparable to that in a study by Taksande et al.  Splenomegaly (27%) was more common compared to hepatomegaly (22%) and hepatosplenomegaly (16%), which is similar to the findings of Muddaiah and Prakash. 
Severe anemia (hemoglobin level <5) was present in 3 patients. All 3 had falciparum malaria. Hemoglobin level 5-10 mg% was present in 43 (37%) patients. Of these, 8 patients had falciparum malaria. This differs from the findings of Mohapatra  who noted incidence of anemia as 6.9% in their study. Kochar et al.  demonstrated increased incidence of severe anemia from (5.83%) in 1994 to 26.04% in 2004 in his study. Total leukocyte count was within normal range in 83 (71%) patients. 23 (19%) patients had total leukocyte count (TLC) <4000/cmm. 12 (10%) patients had TLC >10,000/cmm.
Thrombocytopenia (63%) was the most common complication, which is similar to the findings of Rasheed et al. 
Platelet count of less than 50,000/cmm was present in 29 (25%) patients. Platelet count of 50,000-100,000/cmm was present in 34 (29%) patients. In literature, it is mentioned that thrombocytopenia was a common hematological manifestation in malarial fever.  Although, lower platelet counts are more likely to be seen with falciparum malaria than in cases of vivax infections.
Cerebral malaria was present in 3 (3%) patients. All these cases were caused by either P. falciparum. There was no associated mortality in these patients and they recovered with adequate treatment.
The clinical profile and laboratory parameters were not significantly different between P. falciparum and P. vivax malaria in the present study. Previously, P. vivax was considered the cause of tertian benign malaria that rarely led to a severe form of the disease. However, increasing evidence has shown an increased risk of mortality and morbidity owing to P. vivax malaria. ,,
Malaria is an important medical and public health problem in India. In this study, it is observed that there is no much difference in sociodemographic characteristics of malaria cases due to P. falciparum or P. vivax. Similarly, there is no difference in clinical profile as well as laboratory parameters of malaria cases due to P. falciparum or P. vivax. Malaria due to any Plasmodium must be managed with at most care. More research on the large scale is recommended to get a clearer picture.
Limitations of the Study
It is a retrospective record-based study and data is from only one center.
| Acknowledgments|| |
ICMR-STS-2010 and Dr. A.V. Bhore, Dean, Smt. Kashibai Navale Medical College, Narhe, Pune, Maharashtra, India.
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[Table 1], [Table 2], [Table 3], [Table 4]