Comparison of Hepatic Biochemical Derangements Induced By Falciparum and Vivax Malaria

Objective: To compare the hepatic biochemical derangements induced by falciparum and vivax malaria Study Design: A descriptive study Place and duration of study: Department of Biochemistry, Basic Medical Sciences Institute, JP M C, Karachi from August 2005 to July 2006. Materials and Methods: Total eighty-one patients of different ages and both sexes suffering from acute malaria, confirmed by peripheral blood smear were selected by convenient sampling. Nine out of eighty-one patients were infected by Hepatitis B and C infections and were excluded from the study. Out of seventy-two patients 48(70%) were suffering from malaria by Plasmodium falciparum and 24(30%) from Plasmodium vivax infection. The falciparum infected patients were divided into two groups on the basis of duration of illness. Group 1 comprised of 24 patients complaining of fever with or without rigors ranging from 1 – 7 days. Group 2 also consisted of 24 patients with duration of illness lasting from 8-20 days. Group 3 comprised of 24 Plasmodium vivax infected patients having illness of 1 – 20 days. Samples were analyzed in the Biochemistry Department at Basic Medical Sciences Institute, JPMC, Karachi. Results: Liver was enlarged in 26 (54%) patients suffering from falciparum and 2 (8.3%) from vivax malaria. Spleen was also palpable in 23 (47.9%) patients from falciparum group and 4 (16.7%) from vivax group. This difference was statistically highly significant (P 0.001). Mean value of blood hemoglobin in Plasmodium falciparum group was 9.3±0.27, while in Plasmodium vivax group was 10.6±0.04 and the difference in haematocrit percentage was statistically highly significant (P 0.001). Hyperbilirubinemia was present in 52.7% of patients. The mean value of indirect Bilirubin in case of Plasmodium falciparum group is 2.4±0.32 comparatively higher than plasmodium vivax group showing a statistically significant P value ( 0.01). Difference in the mean value of SGPT and SGOT are statistically highly significant (P 0.001) when results were compared with group I. The results of difference in mean value of alkaline phosphatase was statistically highly significant when group I and group II of Plasmodium falciparum infected were compared, which confirms that, as the duration of illness of Plasmodium falciparum progresses the level of alkaline phosphatase rises. Conclusion: Although significant biochemical derangements were observed in both falciparum and vivax malaria, they were significantly more pronounced in Plasmodium falciparum infection, particularly in the later phase of illness. Therefore, liver function tests should be performed early in the course of Plasmodium falciparum malarial infections in order to prevent complications and to reduce mortality.