Spectral presentation of Plasmodium falciparum malaria in rural Karnataka (Southern India).
Plasmodium falciparum (P. falciparum) malaria is an increasingly recognized cause of malaria in Mandya, a rural pocket of the southern part of India. There is a paucity of detailed clinical studies of naturally acquired infections like malaria from these places. 345 subjects were recruited for the study. Smears positive for falciparum malaria were considered diagnostic. Detailed history, physical examination and required investigations were done in all cases. Three major treatment categories were designated as those who received chloroquine with primaquine, artesunate with mefloquine and quinine with doxycycline. Majority subjects were in the age group of 26 – 35 years, 32% subjects used personal protective measures like mosquito nets. 56% of the subjects belong to the middle socio-economic status. Most subjects sought medical care within 1 to 5 days of onset of symptoms. Fever was the commonest symptom followed by headache, nausea with vomiting, myalgia, cough, altered sensorium, abdominal pain, jaundice. The triad of malaria, fever, pallor and splenomegaly were noted in the study group. Subsets uncomplicated cases (282) of P. falciparum malaria patients responded to chloroquine treatment (12.8%), quinine treatment (10.6%) and to artesunate treatment (76.6%). Some uncomplicated P. falciparum malaria patients (62) received artesunate as second line of treatment and responded well. Those with complicated malaria (125) were treated with artesunate (60) and quinine (65). 4% mortality was observed in this study, i.e. 14 among the complicated P. falciparum malaria group.
Author(s): Ravishankar MS, Mohan ME, Ramesh TP*, Dayananda G