Dr. R Kikon
Malaria continues to be a major global health problem. It may be mentioned that falciparam malaria is still a killer disease even today after spending so much of time money and effort by the government. Right here in Dimapur, this disease seems to have come back with a vengeance especially this year. A few malarial deaths in neighboring Assam made headlines couple of weeks back. After seeing the report we did a retrospective analysis of our hospital admission record of the last three months. We are amazed to see that we have indeed come across a large number of falciparam malaria cases.
In record we have admitted forty patients with falciparam positive infection. This data does not include patients with P. vivax infection. Of the forty-two patients admitted thirty three patients were treated successfully. However we lost nine patients in spite of our best efforts. Out of these nine patients, three died soon after admission or at emergency itself. Four of the patients had history of heavy alcohol consumption in the past few years which might have adversely affected the Outcome. The age ranged from 14- 70 years. Among those who died, seven were male and two were female. All the nine patients had jaundice and renal dysfunction. Six patients were in deep coma and three patients were drowsy and confused on admission.
Thirty three patients could be treated successfully with either quinine or artesunate injection. Out of the thirty three who survived twenty two were males and eleven were females. The age ranged from 2-70 years. The commonest mode of presentation were fever, it was present in all patients. The next commonest symptom was jaundice which was present in up to nineteen patients. Five out these survivors presented with altered sensorium and another six had renal dysfunction two requiring dialysis.
We are sharing this humble experience with our readers because of two things. First of all falciparum malaria is still very common and is not contained in Dimapur area secondly the presentation pattern seems to be different from what we would generally expect that is fever. Jaundice is a very common presentation; we have seen in up to 66% of our patients.
All of them have the notion that they were suffering from viral hepatitis. There were some cases where they have been receiving treatment for jaundice in the form of liver tonic etc. There is a peculiar and rather funny belief among many locals and non locals in Dimapur that jaundice can be washed away with water or plants etc. It is sad to put in record that at least three of our patients who died have been losing precious time washing their jaundice prior to seeking medical advice from doctor till they become serious and comatose.
While one is going through the process of washing the jaundice by his/her healer the malarial parasite are rapidly multiplying jeopardizing one’s life. Even if one is suffering from viral hepatitis, there is no scientific basis for washing away the jaundice either. We are also learning our lesson in hard way and have started screening more vigorously for malarial parasites in all patients coming with jaundice and often we have been rewarded.
We in our little experience found that both quinine and artesunate have been equally effective. We are sharing our initial experience to make our patients and colleagues more aware that jaundice could be the only clinical presentation of severe malaria i.e. falciparam malaria. Thus instead of seeking healing with a “KOBIRAS”(1ocal healer) it is better to consult a doctor and does a laboratory test to confirm it.
We invite inputs from all our esteemed colleagues and want them to share their experience with us so that we all can unitedly fight this greatest killer disease which is becoming a big public health problem in and around Dimapur.
