Study of clinical presentation of falciparum malaria and correlation with laboratory indices of poor prognosis

Hazarimal Choudhary, Prema Ram Choudhary


Background: Severe malaria is a chief cause of death in the North-eastern states of India. The criteria for defining severe malaria have fluctuating over the last many years. Detection of both specific and sensitive clinical features of falciparum malaria to predict death is required to improve clinical management. Therefore, the objective of present study was designed to investigate the clinical presentation of falciparum malaria and correlation with laboratory indices of poor prognosis.

Methods: This prospective observational study was conducted at the R N T Medical College Udaipur, India. Total 53 malarial patients who tested positive for plasmodium falciparum were included. A detailed clinical presentation, haematological and biochemical variables were scrutinized. SPSS-16 software was used for statistical analysis.

Results: Out of 53 patients, 6 (11.3%) patients had (>5%) parasitaemia, 3 (5.66%) patients had schizonts in peripheral blood film, 2 (3.77%) patients had serum creatinine >3.0 mg%, 4 (7.54%) patients had raised SGOT and SGPT and all have been died while 11 (20.75%) patients had haemoglobin <7.1 gm% and amongst these 3 (27.27%) patients were died. Out of 53 patients, 13 patients (24.53%) died. Most of the patients had over lapping features with anemia (13.32%), ARDS, 16.98 %, Jaundice 9.43% and impaired consciousness (32.96%). These four features were responsible for high incidence of mortality in malaria.

Conclusions: Decisively 29 (54.71%) patients were having laboratory indices of poor prognosis and amongst them 19 (65.51%) patients were died. Therefore, our findings confirm that patients who had P. falciparum malaria with laboratory indices of poor prognosis had high incidence of mortality.


ARDS, Clinical presentation, Malaria, Plasmodium falciparum, Poor prognosis, Severe malaria

Full Text:



Khatib Y, Patel R, Sequeria K, Agrawal G, Chikhale N. Hematological and biochemical alterations in malaria and their correlation with Parasitic Index. IOSR J Pharm. 2015;5(9):53-6.

Verma RK, Giri R, Singh N, Verma S, Shrivastav V. A study on clinical presentation and outcome of malaria from an underreported, p. vivax predominant region of north India. Sch. J. App. Med. Sci. 2016;4(1):233-43.

Park JE, Park K: Text Book of preventive and social medicine: Malaria, 23 editions. Jabalpur (MP) India: Banarsidas Bhanot Publishers. 2015;15:188-202.

WHO. Eight report on the world health situation-Implementation of the global strategy for health for all by the year 2000, Second evaluation volume for South East Asia Regio,2000. Available at

World Health Organization. Universal access to malaria diagnostic testing: an operational manual, WHO, Geneva Switzerland, 2011. Available at

Kochar DK, Kochar SK, Agrawal RP, Sabir M, Nayak KC, Agrawal TD, et al. The changing spectrum of severe falciparum malaria: a clinical study from Bikaner (northwest India). J vector borne Dis. 2006;43(3):104.

Bhalli MA. P. falciparum malaria-A review of 120 cases. J Coll Physicians Sur Pak. 2001;11:300-3.

Mohapatra MK. The natural history of complicated falciparum malaria-A prospective study. J Ass Physicians India. 2006;54:848-53.

Field JW, Niven JC. A note on prognosis in relation to parasite count in acute sub tertian malaria. Trans R So Trop Med Hyg. 1937;30:569-74.

Mangal P, Mittal S, Kachhawa K, Agrawal D, Rath B. Analysis of the clinical profile in patients with plasmodium falciparum malaria and its association with parasite density. J Glob infects Dis. 2017;9(7):60-5.

Das LK, Padhi B, Sahu SS. Prediction of outcome of severe falciparum malaria in Koraput, Odisha, India: A hospital-based study. Tropical Parasitol 2014;4(2):105-10.

Bojang KA, Van Hensbroek MB, Palmer A, Banya WA, Jaffar S, Greenwood BM. Predictors of mortality in Gambian children with severe malaria anaemia. Ann Trop Paedia. 1997;17:355-9.

Marsh K, Forster D, Waruiru C, Mwangi I, Winstanley M, Marsh V, et al. Indicators of life-threatening malaria in African children. N Eng J Med. 1995;332:1399-404.

Schellenberg D, Menendez C, Kahigwa E, Font F, Galindo C, and Acosta C, et al. African children with malaria in an area of intense Plasmodium falciparum transmission: Features on admission to the hospital and risk factors for death. Am J Trop Med Hyg. 1999;61:431-8.

World Health Organization. Severe and complicated malaria. Trans R Soc Trop Med Hyg. 1990;84(suppl 2):S1-S65.

World Health Organization. Severe falciparum malaria. Trans R Soc Trop Med Hyg. 2000; 94(suppl 1):S1-S90.

Adams ARD, Maegraith BG. Clinical Tropical Diseases: Malaria. 9th edition. UK: Wiley Blackwell. 1989;20:427-42.

Facer C, Cook G. Parasites in blood and faeces. In: Swash M, Glynn M, Drake WM (editors). Hutchison’s Clinical Methods, 23ed., Bristol, UK. Saunders. 1995;36:427-42.