A Study of Clinical Trends and Prevalance of Malaria in Abbasia Fever Hospital over a Period of Two Years(2016-2017)

Abstract

M alaria is an acute and chronic systemic illness caused by infection with Plasmodium parasites that lives part of its life in humans and part in female Anopheles mosquitoes. It remains one of the major killers of humans, population worldwide. Egypt had eliminated malaria since 1998 until June 14, 2014. Between late May to mid-June, 19 locally-acquired P.vivax malaria cases were identified in one village of the Aswan Governorate. To fulfill the aim of this work, we designed it to study clinical trends and prevalance of malaria in Abbasia Fever hospital over a period of two years. This study was conducted in co-operation between Tropical Medicine Department, Faculty of Medicine, Ain Shams University and Abbasia Fever hospital The current study was conducted on 200 Malarial patients admitted to Abbasia fever Hospital in Cairo to be treated according to the protocol of treatment of malaria which was approved by Ministry of Health in Egypt. All of the studied cases were subjected to the following; full history taking specially (history of travelling to endemic areas of malaria), thorough clinical examination, laboratory investigations, serological tests (Rapid test and Blood film) for diagnosis of malaria. The study shows that 62 patients were Egyptian recruited from malarial areas in Africa and 138 patients were other nationalities, and Sudan was the most malaria-infected place (46.5%) and Nigeria coming next in frequency (16%). Regarding the clinical presentations of the studied group, 85.5% of patients had a fever as presenting symptom, the majority of patients experience sweating & rigors (85.5%) myalgia, jaundice (65%).,(86.5%) had vomiting, (23%) were DCL, (5.5%) had convulsion, (3.5%) with bleeding, (45%) had splenomegaly and (35.5%) had hepatomegaly. In the current study, 56 patients (28%) were admitted at ICU presenting with severe malarial manifestation. The past history of the studied cases was assessed, the study showed 135 patients (67.5) had a past history of malaria infection, 24 patients (12%) had taken chemoprophylaxis. According to the treatment of malaria, the present study revealed that the best response in studied cases was to the mono-therapy. Concerning the clinical outcome of the studied cases, most of the studied cases (189 patients) were cured in the sense of clinical and parasitological improvement Regarding comparative results among the studied cases, complicated malaria was more frequent in male and non-Egyptian and pregnant women. No significant difference between complicated and non-complicated cases regarding nethier history of exposure to malaria or receiving prophylaxsis. Cases with complications significantly had lower GCS, more frequent jaundice, convulsions, splenomegaly, hepatomegaly, DCL, severe grade and ICU admission. Index, ESR, creatinine, AST, ALT and total bilirubin was significantly higher in complicated case. Signifciantly lower platelets and Plasmosium falciparum type was more frequent among complicated cases IV Artesunate & quinine and dialysis were significantly more frequent among complicated cases. Short stay, death and poor prognosis were significantly more frequent among complicated cases. So, Malaria should be considered as a cause of fever in relevant target patients. Severe malaria is a medical emergency. After full efficient clinical assessment and confirmation of the diagnosis by thick blood film, full doses of mono-therapy antimalarial treatment should be started without delay.