Introduction: Malaria is still one the most important protozoan disease causing significant mortality. One of the causes may be because of atypical presentation of the disease resulting in delay in diagnosis and treatment.  Jaundice is one the important predictors of severity of the disease. Jaundice when present alone indicates severe disease and when in combination with other complications ARF (Acute Renal Failure) indicates poor prognosis.

Material and Method: A hospital based prospective observational study was done on 71 confirmed cases of P. falciparum malaria admitted in our hospital from July 2017 to August 2018.

Result:  The total no. of cases in the study was 71. The mean age of the patients was 34.76 ± 12.81 years. Majority of the cases (49) were seen in age group 20 -39 years (69.01%).  On looking at the sex distribution, total no. of cases among males were 53 (74.64%) and 18 were females (23.35%), no. of males was more than females. Majority of the patients came from rural areas 51 (71.83%) as compared to urban areas 20 (28.17%) this may be due to poverty, lack of proper education and  living in unhygienic conditions. 32.39% of the patients (23) were tribal and 67.61 % (48) were non-tribals. According to serum bilirubin levels, patients were classified into two Groups A (53 patients, serum bilirubin <3 mg/dl), B (18 patients, serum bilirubin > 3 mg/dl). Group B patients had total bilirubin, direct bilirubin, indirect bilirubin, serum glutamic oxaloacetic transaminase, SGPT, and alkaline phosphatase levels in the range of 9.67±7.37 mg/dl, 5.22±4.31mg/dl, 4.46±3.85 mg/dl, 119.39± 99.07 IU/L, 62.22±40.18 IU/L, and 126.17±46.12 U/L, respectively.

Conclusion: We suggest that jaundice in P. falciparum malaria can serve as an important prognostic factor indicating a severe disease as serum bilirubin rises. When it is associated with ARF prognosis becomes bad. Jaundice with fever in an malaria endemic country like India, P. falciparum malaria should always be ruled out.

Keywords: Hyperbilirubinaemia, Malarial hepatitis, Acute Renal Failure, Falciparum malaria.

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Dr Manmeet Topno

Junior Resident, Rajendra Institute of Medical Sciences, Ranchi

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