Studies Pertaining to the Clinical Aspects of Malaria

STUDIES PERTAINING TO THE CLINICAL ASPECTS OF MALARIA

Malaria is a complex condition exhibiting different manifestations in different parts of the world depending on a few variables (Bin Mohanna et al. 2007). It was found that anemia and splenomegaly are significantly associated with malaria among asymptomatic schoolchildren in Hajr valley, Hadramout (Bin Mohanna et al. 2007). Agina and Abd-Allah (1999) conducted a case control study for the association of nitric oxide levels to the severity and outcomes of cerebral malaria in Yemeni in-patients. The main clinical presentations in cerebral malaria patients were fever (76.4%), pallor (72.0%), hypoglycemia (67.4%), splenomegaly (60.5%), deep coma (39.5%), jaundice (18.6%), pulmonary oedema (13.9%), subconjunctival hemorrhage (13.9%), severe anemia (53.5%), and hemoglobinuria (6.9%) while in non-cerebral malaria patients the clinical presentations were fever (83.8%), pallor (67.7%), splenomegaly (66.0%), jaundice (9.7%), severe anemia (51.6%) and hypoglycemia (3.2%) . The serum level of nitric oxide was found to be higher in patients with cerebral malaria than those without. In cerebral malaria, nitric oxide levels were highly elevated in patients with deeper coma and longer duration of coma as well as those who died of cerebral malaria indicating its association with indices of disease severity and outcome in patients with cerebral malaria (Agina and Abd-Allah, 1999).

Sheiban et al. (1998) studied severe acute renal failure secondary to falciparum malaria among children receiving antimalarial therapy and other supportive therapy as well as peritoneal dialysis referred to the renal unit at Al-Thawra Hospital in Sana’a. In this study, it was concluded that significant differences were found between children who died (43.8%) compared to those who survived regarding age, plasma creatinine, plasma bilirubin, systolic and diastolic blood pressure, hemoglobin concentration, urine output, and time from diagnosis to referral. However, gender, alanine aminotransferase level, degree of fever, plasma sodium or potassium levels were not found to be statistically different between these two groups (Sheiban et al. 1998). The author found that previous immunity, as indicated by presence of splenomegaly, was associated with better prognosis both in terms of lower mortality and less hemodynamic disturbance which was evident in the older children owing to previous exposure to malarial infection, and therefore development of immunity (Sheiban et al. 1998). It is important to note that malaria was reported to be the cause of 5.9% of chronic renal failure in patients undergoing regular hemodialysis in Hadramout governorate (Badheeb 1998). Recently, Al Rohani et al. (2011) reported that malaria is the most common infectious disease causing acute renal failure (ARF) in Yemeni patients.