Association of clinical features with P.falciparum positivity in a tertiary care hospital in north India

Author(s): Snehanshu Shukla*, Vimala Venkatesh, Mastan Singh, Harshita Pant

Abstract

Classical malaria due to any of the species present with typical clinical paroxysm which consists of three stages, an initial chill stage, febrile stage and the third stage or sweating stage. Infections with P. falciparum can however deteriorate very quickly to more severe presentations, now defined under the broad terms of severe malaria. The study aims to guide the clinicians in tertiary care settings to correlate the clinical sign and symptoms prior to starting the anti-malarial on clinical suspicion alone so as to minimize the emerging problem of anti-malarial drugs overdose and resistance. The present study was conducted in Postgraduate Department of Microbiology, CSMMU (now King George’s Medical University), Lucknow over a period of one year from August 2008 to August 2009. The study was carried out as a hospital based observational study. Blood samples were collected in EDTA vials. Each sample was examined by Giemsa stained thick and thin smears. Chi square test, Inter-observer Differences (“Kappa”), Logistic Regression, Multivariate Analysis were used to predict the outcomes. A total of 107 samples from clinically suspected cases of malaria were enrolled for the study from the medicine and pediatric wards of Gandhi Memorial and Associated Hospitals, CSMMU, Lucknow, out of which 42 samples were positive for P.falciparum infection. A statistically significant (p < 0.001) association of Fever with continuous pattern was the most common clinical features while diarrhoea and decreased renal out-put were the least common. Hypotension/collapse and haemoglobuminuria were found to be absent in all the cases. Among the observed clinical features only temperature >102oF, vomiting, altered consciousness, jaundice and anaemia seem to be significantly associated with the outcome Microscopic Positivity. The clinical criteria for malaria diagnosis though very strict and less sensitive, has very high specificity, i.e. clinical criteria has the capability to rule out the negative cases effectively.

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