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A STUDY OF CLINICAL PROFILE OF MALARIA AND ITS ACUTE COMPLICATIONS CAUSED BY DIFFERENT SPECIES OF PLASMODIUM IN CHILDREN.

BACKGROUND

Malaria is an insect-borne parasitic infection of tremendous global importance. According to the WHO, there were 214 million cases and 438, 000 deaths attributed to malaria in 20151. A declining trend has been observed in the global incidence of malaria in recent years; in paediatric malaria also, the incidence decreased from 33% in 2000 to 16% in 2015. [1] India alone contributes 80% of south East Asia malaria burden. [2] India has by far the greatest estimated Plasmodium vivax burden of any country. Around 30% of all P. vivax cases in India occur in children aged 1-14 years, though these represent just 12% of the total population. [3] In a recent study by "million death collaboration", it was estimated that malaria accounts for 205, 000 deaths per year in India, with 55, 000 deaths occurring in early childhood. [3] Among the different human species of these protozoa, Plasmodium falciparum is responsible for most fatalities. [1]

Young children manifest this disease in many different ways, but the classic picture of malaria, with periodic fever, shivering, and sweating, is not observed. Children are at highest risk for severe disease and death between six months and five years of age: during this period children are most vulnerable as they have lost maternal immunity and they haven't yet developed specific immunity to infection.

Haematological and biochemical parameters are often abnormal: Features of severe or complicated malaria include respiratory distress, acidosis (pH <7.3), hypoglycaemia (<2.2 mmol/l), elevated aminotransferases, severe anaemia (Hb <5 g/dl), and high parasitaemia (defined as >5%-10% infected erythrocytes or more than 500 000 infected erythrocytes per microliter) [4]. Considering the above facts, the present study was undertaken to find out the spectrum of clinical manifestations, infecting species, age distribution and complications in children admitted with malaria.

Aim of The Study

To assess the clinical profile and complications caused by different species of plasmodium in children with malaria.

MATERIALS AND METHODS

This is a descriptive study conducted at Government District General Hospital, Vizianagaram, Andhra Pradesh, in the Department of paediatrics for a period of one year from June 2017 to May 2018. Children from ages of 1 month to 15 years of age diagnosed with malaria by standard laboratory tests are enrolled until sample size is attained after taking due consent. The study protocol is approved by Ethical committee.

Inclusion Criteria

1. Children from 1 month to 15 years of age admitted in paediatric ward diagnosed with malaria.

2. Diagnosis of malaria was done by using Smear for malarial parasite and/or RDT.

Exclusion Criteria

1. Children on empirical treatment for malaria but later found negative.

2. Children not willing to participate.

3. Children with other infections like enteric fever, meningitis, TB etc with coincidental smear positivity for malaria.

Statistical Analysis

Data entry and statistical analysis was performed with the help of Microsoft excel 2007 and SPSS version 20.0, while categorical variables are presented as number and percentages. Chi-square test is used to compare differences in categorical variables. The statistical significance level is fixed at p<0.05.

Majority of the study subjects belong to age group of <5 years (50.9%), followed by age group of 5-10 years (36%) and 11-15 years (13.2%).

64% of the study subjects are boys and 36% by girls (36%).

Majority of the study subjects belong to tribal locality (72.8%), followed by rural (24.6%) and urban (2.6%).

All the study subjects presented with fever (100%). 47.4% presented with vomiting, 44.7% with headache, 38.6% study subjects presented with abdominal distension, 29.8% with myalgia, 22.8% presented with loose stools, 21.1% presented with altered sensorium, 18.4% presented with pallor, Jaundice observed in 7.9%, bleeding in 7.0%, convulsions in 6.1%, dark urine in 4.4% and shortness of breath in 1.8% of the study subjects.

Majority of the study subjects presented with splenomegaly (74.6%), followed by pallor (45.6%), icterus (10.5%) and hepatosplenomegaly (10.5%).

In our study, the most common complication was anaemia (35.08%) followed by hepatitis (11.40%), Bleeding diathesis (5.36%), cerebral malaria (5.26%), hypoglycaemia (3.50%), renal failure (3.50%), metabolic acidosis (3.50%), pulmonary oedema (1.75%), repeated convulsions (0.87%) and shock (0.87%).

Out of 40 anaemic patients, majority (62.5%) belongs to <5 years. Out of 4 hypoglycaemic patients, majority (75%) belongs to < 5 years. Out of 6 cerebral malaria patients, all belongs to <5 years. Out of 13 hepatitis patients, majority (53.8%) belongs to 5-10 years. Out of 4 patients with renal failure, majority (50%) belongs to <5 years. Out of 6 patients with bleeding diathesis, majority (50%) belongs to 5-10 years. Out of 4 patients with metabolic acidosis, majority (75%) belongs to <5 years. One patient had repeated convulsions in the age group of 5-10 years. One patient had shock in the age group of <5 years. Statistical significance was found in cerebral malaria and hepatitis.

In smear for MP, PF is positive in 75.4%, PF+PV in 7% and PV in 17.5% cases. In RDT, PF is positive in 71.9%, PF+PV in 11.4% and PV in 16.7% cases.

Out of 13 patients with increased TSB, majority (69.2%) were PF positive. Out of 6 patients with decreased RBS, majority (66.7%) were PF positive. Out of 5 patients with abnormal RFT, all were PF positive. But the association between them was found to be statistically not significant.

Patients with bleeding, convulsions, dark urine, shortness of breath are 100% positive for PF. Patients with Pallor and altered sensorium are around 80-90% positive for PF. Patients with fever, headache, myalgia, vomiting, loose stools, abdominal distension, jaundice are around 70-80% positive for PF.

Hepato-splenomegaly is present in 83.3% PF positive cases, splenomegaly is present in 80% PF positive cases, pallor is present in 78.8% PF positive cases and icterus in 75% PF positive cases. Splenomegaly in falciparum and vivax species shows statistical significance.

Patients with complications of cerebral Malaria, renal failure, bleeding diathesis, metabolic acidosis, pulmonary oedema, repeated convulsions, shock are 100% positive for PF. Anaemia is present in 80% PF positive cases, hypoglycaemia in 75% PF positive cases and hepatitis in 69.2% PF positive cases.

PF positive have 54.7%, PF+PV positive have 50%, PV positive have 75% of patients with haemoglobin of >7.0-10 g/dl. But the association between them is not statistically significant.

97.4% patients recovered from illness, death occurred in 1.8% patients.

98.3% patients recovered in <5 years age group, 97.6% patients recovered in 5-10 years age group and 93.3% patients recovered in 11-15 age group years. But the association between them was found to be statistically not significant.

DISCUSSION

1. Majority of the study subjects belong to age group of <5 years (50.9%), followed by age group of 5-10 years (36%) and 11-15 years (13.2%). In a study by Tarakeswara Rao et al, [5] Majority of the study subjects belong to age group of <5 years (47.2%), followed by age group of 5-10 years (29.6%) and 11-15 years (19.4%). In the study by Sathpathy et al [6] 62.8% cases of malaria were above 5 years.

2. Majority of the study subjects were boys (64%) followed by girls (36%).

3. All the study subjects presented with fever (100%). Majority of the patients presented with vomiting (47.4%) and headache (44.7%). 38.6% study subjects presented with abdominal distension, 29.8% presented with myalgia, 22.8% presented with loose stools, 21.1% presented with altered sensorium, 18.4% presented with pallor, Jaundice in 7.9%, bleeding in 7.0%, convulsions in 6.1%, dark urine in 4.4% and shortness of breath in 1.8% of the study subjects.

Symptoms

Fever

100% of patients had complained of fever. A study by Murthy GL et al [7] showed that fever 77 with chills and rigors in 98.10% of patients which is comparable. Another study by Talib VH et al [8] showed it to be 97.76%.

Headache

Headache was present in 44.7% of patients. It was present in 33.4% in study by Murthy GL et al [7] and 33.45% in study by Mehta SR et al. [9]

Myalgia

In our study it was seen in 29.8% of patients. The study by Talib VH et al [8] showed it was in 67.59%.

Vomiting

In our study it was present in 47.4% of patients. In study by S.R. Mehta SR et al [9] it was 8.47% and study by Talib VH et al [8] it was 57.75%.

Jaundice

Yellowish discoloration of eyes was complained by 10.5% of our patients. It was 23.41% in study by Murthy GL et al [7]. High incidence of jaundice was because of the haemolysis caused by malaria parasite.

Diarrhoea

22.8% of our patient had diarrhoea. In the study by Murthy GL et al [7] it was 5.64%

4. Bleeding

The incidence was 7% in our study. It was 4.43% in the study by Murthy GL et al. [7]

Splenomegaly was present in 63% cases in our study.

This finding is consistent with study by Milind BK et al [10] where splenomegaly was present in 53% of cases. Hepatomegaly was seen in 52% cases in our study. In a study by Milind BK et al [10] hepatomegaly was seen in 47% of cases.

5. In smear for MP, PF is positive in 75.4%, PF+PV in 7% and PV in 17.5% cases. In RDT, PF is positive in 71.9%, PF+PV in 11.4% and PV in 16.7% cases. [??] In a study by Verma P et al, [11] Maximum number of patients were of Pf (57.8%); Pv was documented in 13.7% and mixed infection in 27.4% cases.

6. Patients with bleeding, convulsions, dark urine, shortness of breath were 100% positive for PF. Patients with Pallor and altered sensorium were around 80-90% positive for PF. Patients with fever, headache, myalgia, vomiting, loose stools, abdominal distension, jaundice were around 70-80% positive for PF.

7. Hepato-splenomegaly is present in 83.3% PF positive cases, splenomegaly is present in 80% PF positive cases, Pallor is present in 78.8% PF positive cases and icterus is present in 75% PF positive cases. Splenomegaly shows statistical significance.

8. Patients with complications of cerebral Malaria, renal failure, bleeding diathesis, metabolic acidosis, pulmonary oedema, repeated convulsions, shock were 100% positive for PF. Anaemia is present in 80% PF positive cases, hypoglycaemia is present in 75% PF positive cases and hepatitis is present in 69.2% PF positive cases.

9. In our study, the most common complication was anaemia (35.08%) followed by hepatitis (11.40%), Bleeding diathesis (5.36%), cerebral malaria (5.26%), hypoglycaemia (3.50%), renal failure (3.50%), metabolic acidosis (3.50%), pulmonary oedema (1.75%), repeated convulsions (0.87%) and shock (0.87%).

* In a study by Murthy GL et al, [7] anaemia (74.6%) and cerebral malaria (48.1%) were the common manifestations.

* In a study by Kochar et al, [12] anaemia were most common manifestations followed by DIC and cerebral malaria. This shows that the spectrum of common manifestations and complications of malaria vary in different geographical regions depending upon parasitic factor, epidemiological factors and host defence factors.

10. PF positive cases (54.7%), PF+PV positive cases (50%), PV positive cases (75%) are more in patients with haemoglobin of >7.0-10 g/dl. But the association between them was found to be statistically not significant.

11. 97.4% patients recovered from illness, death occurred in 1.8% patients. The Overall mortality was 1.8% in our study. Out of 2 deaths, one due to falciparum and another due to vivax. 98.3% patients recovered in <5 years age group, 97.6% patients recovered in 5-10 years age group and 93.3% patients recovered in 11-15 age group years. But the association between them was found to be statistically not significant.

CONCLUSION

Majority of the subjects in this study were <5 years of age and most were males. All the study subjects presented with fever. Majority of the patients also had vomiting and headache. A third of patients had abdominal distension and myalgias. Less prevalent symptoms were bleeding, convulsions, dark urine and shortness of breath. On examination, majority of the subjects had splenomegaly and pallor. Complications like anaemia, hypoglycaemia, renal failure, cerebral malaria, metabolic acidosis, shock were more prevalent in <5 years age group. Majority were infected with falciparum malaria and also had more complications. Cerebral malaria, renal failure, bleeding diathesis, metabolic acidosis, pulmonary oedema, repeated convulsions, shock were noted only in falciparum malaria. Mortality was 1.8% in this study. Majority of patients recovered.

REFERENCES

[1] World Health Organisation. World Malaria report. Geneva: 2015. http://apps.who.int/iris/bitstream/10665/200018/1 /9789241565158_eng.pdf.

[2] Kumari M, Ghildiyal R. Clinical profile of plasmodium vivax malaria in children and study of severity parameters in relation to mortality: a tertiary care centre perspective in Mumbai, India. Article ID 765657, Hindawi Publishing Corporation, Malaria Research and Treatment 2014;2014:1-6.

[3] Strategic plan for malaria control in India. 2012-2017: A five-year strategic plan. Directorate of National Vector Borne Disease Control Programme. Directorate General of Health Services. Ministry of Health & Family Welfare, Government of India. http://nvbdcp.gov.in/Doc/Strategic-Action-Plan-M alaria-2012-17-Co.pdf. Accessed May 23, 2018.

[4] Schumacher RF, Spinelli E. Malaria in Children. Mediterr J Hematol Infect Dis 2012;4:1-12.

[5] TarakeswaraRao P, Prudhvi K. Clinical Profile of admitted children with malarial fever: a retrospective study. Int J Pediatr Res 2016;3(9):678-82.

[6] Satpathy SK, Mohanty N, Nanda P, et al. Severe falciparum malaria. Indian J Pediatr 2004;71(2):133-5.

[7] Murthy GL, Sahay RK, Srinivasan VR, et al. Clinical profile of falciparum malaria in a tertiary care hospital. J Ind Med Assoc 2000;98(4) :160-2, 169.

[8] Talib VH, Hasija BD, Diwan VM, et al. A clinico haematological profile of malaria. J Assoc Physicians India 1982;30(6):402-4.

[9] Mehta SR, Naidu G, Chandar V, et al. Falciparum malaria-present day problems--an experience with 425 cases. J Assoc Physicians India 1989;37(4):264-7.

[10] Milind BK, Pradeep PR, Hussain ZF. Cerebral malaria in rural India. Indian J Pediatr 2002;69(8):659-61.

[11] Verma P, Shukla US, Kalraiya A. Retrospective study on clinical profile of severe malaria in children admitted in a tertiary care centre of Central India. People's Journal of Scientific Research 2014;7(1):22-6.

[12] Kochar DK, Kochar SK, Agarwal RP. The changing spectrum of severe falciparum malaria: a clinical study from Bikaner (northwest India). J Vector Borne Dis 2006;31(9):2278-84.

[13] Mohapatra MK. The Natural history of complicated falciparum malaria--a prospective study. J Assoc Physicians India 2006;54:848-53.

[14] Al-Taiar A, Jaffar S, Assabri A, et al. Severe malaria in children in Yemen: two site observational study. Brit Med J 2006;333(7573):827-32.

[15] Mockenhaupt FP, Ehrhardt S, Burkhardt J, et al. Manifestation and outcome of severe malaria in children in northern Ghana. Am J Trop Med Hyg 2004;71(2):167-72.

A. Vidyullatha (1), V. C. Srinivas Reddy (2), Ch. Lakshmi Madhulika (3)

(1) Associate Professor, (Designated), Department of Paediatrics, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India.

(2) Associate Professor, (Designated), Department of General Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India.

(3) DNB Resident, Government District General Hospital, Department of Paediatrics, Vizianagaram, Andhra Pradesh, India.

'Financial or Other Competing Interest': None.

Submission 07-01-2019, Peer Review 15-02-2019,

Acceptance 22-02-2019, Published 04-03-2019.

Corresponding Author:

Dr. V. C. Srinivas Reddy,

Associate Professor, (Designated),

Department of General Medicine,

Andhra Medical College, Visakhapatnam,

Andhra Pradesh, India.

E-mail: drvcsr@yahoo.co.in

DOI: 10.14260/jemds/2019/134
Table 1. Age Distribution

RESULTS

Age Category    Frequency    Percent

<5 YEARS           58          50.9

5-10 YEARS          41         36.0

11-15 YEARS          15        13.2

Total                114        100.0

Mean [+ or -] SD = 5 9704 [+ or -] 3 77861

Table 2. Gender Distribution

Gender    Frequency    Percent

Girls         41            36%
Boys          73            64%

Total         114           100%

Table 3. Distribution of Children Based on Their Locality

Locality    Frequency    Percent

Rural          28           24.6%
Tribal         83           72.8%
Urban           3            2.6%
Total          114           100%

Table 4. Clinical Presentation of Malaria

      Symptoms         Frequency       Percent

Fever                     114           100%
Headache                   51           44.7%
Myalgia                    54           29.8%
Vomiting                   54           47.4%
Loose stools               26           22.8%
Abdominal distension       44           38.6%
Jaundice                   9            7.9%
Bleeding                   8            7.0%
Pallor                     21           18.4%
Altered Sensorium          24           21 1%
Convulsions                7             61%
Dark urine                 5            4.4%
Shortness of Breath        2            1.8%

Table 5. Clinical Signs of Malaria

Signs                 Frequency       Percent

Pallor                     52           45.6%
Icterus                    12           10.5%
Hepatosplenomegaly         12           10.5%
Splenomegaly               S5           74.6%

Table 6. Complications of Malaria

Complications          Frequency     Percent

Anemia                     40          35.08%
Hypoglycemia                4           3.50%
Cerebral Malaria            6           5.26%
Hepatitis                  13          11.40%
Renal failure               4           3.50%
Bleeding diathesis          6           5.36%
Metabolic acidosis          4           3.50%
Pulmonary' edema            2           1.75%
Repeated convulsions        1           0.87%
Shock                       1           0.87%

Table 7. Complications of Malaria According to Age Groups

Complications          <5 Yrs          5-10 Yrs
                         n       %        n        %

Anemia                   25     62.5      12       30
Hypoglycemia             3       75       1        25
Cerebral Malaria         5      100       0        0
Hepatitis                2      15.4      7       53.8
Renal failure            2       50       1        25
Bleeding diathesis       2      a 3       3        50
Metabolic acidosis       3       75       1        25
Pulmonary edema          2      100       0        0
Repeated convulsions     0       0        1       100
Shock                    1      100       0        0

Complications          11-15 Yrs          Total   P value
                           n       %

Anemia                     3       7.5    40      0.15
Hypoglycemia               0       0      4       0.56
Cerebral Malaria           0       0      6       0.04 *
Hepatitis                  4       30.8   13      0.01 *
Renal failure              1       25     4       0.74
Bleeding diathesis         1       16.7   6       0.67
Metabolic acidosis         0       0      4       0.56
Pulmonary edema            0       0      2       0.37
Repeated convulsions       0       0      1       0.40
Shock                      0       0      1       0.61

Table 8. Laboratory Tests for Diagnosis
RDT- Rapid Diagnostic Test, MP- Malarial Parasite

Laboratoiy             Smear for MP             RDT

tests          Frequency     Percent   Frequency   Percent

PF                 86         75.4        82        71.9
PF+PV              8           7.0        13        11.4
PV                 20         17.5        19         167
Total             114          100        114        100

Table 9. Profile of Other Laboratory Parameters
TSB-Total Serum Bilirubin. RBS-Random blood sugar, RFT
Renal function of test

Laboratory       PF          PF+PV          PV          Total     P
Investigations                                                  Value
                 n     %       n      %     n     %

Increased TSB    9    69.2     2     15.4   2    15.4    13     0.45
Decreased RBS    4    66.7     0      0     2    33.3     6     0.49
Abnormal RFT     5    100      0      0     0     0       5     0.42

Table 10. Symptoms in Various Species of Plasmodium

Symptoms       PF          PF-PY          PY          Total   p
                                                              value
               n           n       %      n    %

Fever          83   75 4   S              20   17.5   114     --
Headache       38   74.5   3       59     10   19 6   51      0.81
Myalpa         21   79.4           2.0    6    17.6   34      O.53
Vomiting       43   79.6   6       11.1   5    93     54      0.03 *
Loose stools   19   69 2           3.8    6    11.1    26      0.57
Abdominal      52   72.7   4       9.1    8    18.2    44      0 55
distension
Jaundice            77.8           11.1   1    11.1    9       0.79
Bleeding       S    100    0       0      0    0       8       0.24
Pallor         18   85.7           4.8         9.5    21       0.47
Altered        20   83.3           8.3     2   8.3    24         0
Sensonum
Convulsions         100    0       0      0    0              0.29
Dark urine     5    100    0       0      0    0      5       0.42
Shortness of   2    100    0       0      0    0      2       0.71
Breath

Table 11. Signs in Various Species of Plasmodium

               PF          PF-PY         PV          Total     P
               n     %       D      %    n     %             Value

Pallor         41   78 8     2     3 8   9    17.3    52     0 49
Icterus        9     75      1     8 3   2    16.7    12      091
Hepato-        16   83 3     1     8.3   1    8.3     12     0.56
splenomegaly
Splenomegaly   68    80      5     5 9   12   14.1    85     005 *

Table 12. Complications in Various Species of Plasmodium

Complications      PF                PF+PV  PV        Total     P
                                                              Value
                   n     %     n     %    n     %
Anemia             32    80    3    7.5   5    12.5    40     0.58
Hypoglycemia       3     75    1    25    0     0       4     0.26
Cerebral Malaria   6    100    0     O    0     0       6     0.35
Hepatitis          9    69.2   1    7,7   3    23.1    13     0,84
Renal failure      4    100    0     0    0     0       4     0.50
Bleeding           6    100    0     0    0     O       6     0.35
diathesis
Metabolic          4    100    0     0    0     O       4     0.50
acidosis
Pulmonary edema    2    100    0     0    0     0       2     0.71
Repeated           1    100    0     0    0     0       1     0.94
convulsions
Shock              1    100    0     0    0     O       1     0.84

Table 13. Association Between Anaemia and Species of
Plasmodium

                                  Smear for MP                Total
                                    PF     PF+PV      PV

Haemoglobin   <5.0 g/dl      n      26       2        4        32
category                     *4   30.2%    25.0%    20.0%     28.1%
              5.0-7.0 g dl   n      13       2        1        16
                             %    15.1%    25.0%     5.0%     14.0%
              >7.0-10.0     Q      47       4        15       66
              g dl           %    54.7%    50.0%    75.0%    57.90%
Total                        a      86       S        20       114
                             %    100.0%   100.0%   100 0%   100.00%

Table 14. Distribution of Outcome

Outcome     Frequency   Percent

Death           2         18%
Recovered      111       97.4%
Referral        1        0.9%
Total          114       100%

Table 15. Association Between Outcome and Age Category

                          Age category               Total
                            <5      5-10    11-15
                          YEARS    YEARS    YEARS

Outcome     Death     n     1        0        1        2
                      %    1.7%     0.0%     6.7%     1.8%
          Recovered   n     57       40       14       in
                      %   98.3%    97.6%    93.3%    97.4%
          Referral    n     0        1        0        1
                      %    0.0%     2.4%     0.0%     0.9%
 Total                n     58       41       15      114
                      %   100.0%   100.0%   100.0%   100.0%

Table 16. Comparison of Gender in Different Studies

         Murthy   Talib   Sathpathy   Tarakeswara   Present
Gender   GL et    et VH    SK et         Rao        Study
         al [7]    al [8]  al [6]      et al [5]

Boys     69.6%    66.7%     62.5%        67.6%      64.0%
Girls    31.4%    33.3%    37.5%        32.4%      36.0%

Table 17. Comparison of Clinical Features in Different Studies

Clinical Features       Mehta SR    Murthy GL    Talib VH
                        et al [9]   et al [7]    et al [8]

Fever                     94.6%       98.10%      97.76%
Headache                 33.45%       33.4%       73.81%
Myalgia                    --           --        67.59%
Vomiting                  8.47%         --        54.75%
Diarrhoea                  --         5.64%         --
Breathlessness            1.17%      0.63% %        --
Convulsion                 --         2.53%         --
Bleeding                  0.7%        4.43%        0.16%
Pallor                     --           --          --
Icterus                   2.58%       23.41%        --
Splenomegaly               --           --        29.60%
Hepatosplenomegaly         --           --        24.58%

Clinical Features       Tarakeswara     Present
                        Rao et al [5]    Study

Fever                       100%          100%
Headache                     --          44.7%
Myalgia                      --          29.8%
Vomiting                     --          47.4%
Diarrhoea                    --          22.8%
Breathlessness              13.9%         1.8%
Convulsion                  18.5%         6.1%
Bleeding                     --            7%
Pallor                      43.5%        45.6%
Icterus                     10.2%        10.5%
Splenomegaly                28.7%        74.6%
Hepatosplenomegaly          25.9%        10.5%

Table 18. Comparison of Complications in Different Studies

Complication            Murthy GL      Kochar       Mohapatra
                        et al [7]   DK et al [12]    MK [13]

Anaemia                  74.68%        26.04%         6.9%
Cerebral Malaria          48.1%        10.94%         74.3%
Acute Renal Failure      24.68%         6.25%          --
Hypoglycaemia             8.22%         1.56%          --
Hypotension/Shock-         --          10.94%          --
Bleeding Diathesis       16.45%        25.52%          --
Pulmonary Oedema         11.39%         2.08%          --

Complication            Satpathy    Al-Taiar A   Mockenhau   Present
                        et al [6]   et al [14]    Pt [15]     study

Anaemia                    26%         37%          55%      35.08%
Cerebral Malaria           40%          8%          17%       5.26%
Acute Renal Failure        14%          9%          --        3.50%
Hypoglycaemia              13%          8%          17%       3.50%
Hypotension/Shock-          -           --          --        0.87%
Bleeding Diathesis        3.7%          3%          --        5.36%
Pulmonary Oedema           2%           --          --        1.75%

Table 19. Comparison of Haemoglobin in Different Studies

Haemoglobin (gm %)   Murthy GL    Present
                     et al [7]     Study

Mild (>7-10)           43.67%      57.9%
Moderate (5-7)         21.51%       14%
Severe (<5)            9.49%       28.1%

Table 20. Comparison of Mortality Rate in
Different Studies

               Kochar      Sathpathy    Al Taiar A    Mockenhaupt
              et al [12]   et al [6]    et al [14]        [15]

Mortality %     10.93%        9.9%         3.2%          11.2%

              Tarakeswara     Present
              Rao et al [5]    Study

Mortality %       5.5%          1.8%
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Title Annotation:Original Research Article
Author:Vidyullatha, A.; Reddy, V.C. Srinivas; Madhulika, Ch. Lakshmi
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Geographic Code:9INDI
Date:Mar 4, 2019
Words:4075
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