A Study on Relationship of Thrombocytopenia and Likelihood of Severe Malaria in Patients Admitted With Malaria in a Tertiary Care Hospital of Dakshina Kannada

Abstract

Background: Malaria continues to be a huge socioeconomic burden despite various measures taken to curb the spread worldwide. It is also a global concern and more so in countries with a resource-limited setting. This inspired us to look at variables that could represent a severe disease in those limited settings, one such parameter being thrombocytopenia in malaria.   Aims and Objectives: To find the relationship between thrombocytopenia and renal failure, hepatic dysfunction and cerebral malaria (severe malaria) and to identify if thrombocytopenia on the first day of admission increases the likelihood of severe malaria. Methods: The study included 85 patients admitted in Yenepoya medical college hospital with fever and peripheral smear or malarial parasite fluorescent test (MPFT) positive for Plasmodium species. Results: A total of 85 patients were included in the study. It was noted that the patients with profound thrombocytopenia (<20,000/ml) on day 1 were more commonly associated with manifestations of severe malaria-like cerebral malaria, renal failure, and jaundice. Platelet count of <50,000/ml was associated with increased incidence of  renal failure, hepatic dysfunction, and cerebral malaria and increased mortality by an odds ratio of 4.37 on multivariate analysis. Conclusions: It was noted in our study that the presence of thrombocytopenia in a case of acute febrile illness increases the probability of malaria. This finding along with clinical suspicion of malaria should entail early treatment initiation. We have also noted that the presence of profound and severe thrombocytopenia was found to have a statistically significant correlation with cerebral malaria, renal failure and jaundice, and increased mortality.