Introduction
Protozoan disease malaria is a sickness transferred by the bite of infected anopheles mosquitoes and it is most severe parasitic sicknesses in the world affecting 400-500 million populaces and affecting over 1 million losses each year. Around 2.5 million malaria ceases are informed annually from south Asia of which 75% are described in India.1 Malaria continuous via be a chief communal fitness issued in India. Accordingly, to WHO report in 2014 around 1.08 million malaria cases and 332 deaths were reported at communal level in India.2 Malaria is a significant infections vectors born disease caused by Plasmodium species. There are 5 types of plasmodia species. P.vivax, P.falciparum, .P.ovale, P. malaria, P.knowlesi It is 94% of the death from malaria is cause by P.falciparum and vivax but P.vivax is the most common causes of malaria infectious in humans.3 They are severely life threatening complication of malaria such as cerebral malaria. Severe pernicious anaemia, black water fever.4 The malaria can be a very serious illness and potentially fatal. The malaria parasite is frequently affected to the kidney, liver, and brain. There is severe malaria infection recognised by acute renal failure and hepatic malfunction. Renal failure when the presence of oliguria and increase level of creatinine and blood urea.5 Malaria parasite undergoes two cycle of development-Asexual cycle: man - intermediate host.Sexual cycle: mosquito -definitive host.6 These are cycle in man comprises of 4 stages:-Pre-erthrocytic cycle, Exo-erthrocytic cycle in liver, Secondryerthrocytic stage in RBCs, Gametogony cycle- in mosquito.7 The incubation period varies with deferent clinical plasmodia spp. This usually ranges from 7-30days. But may be up to months or even longer after the bite of an infected anopheles mosquito. 8 The clinical symptom of malaria typical case develops within ten days to four weeks after the infection. 9
Materials and Methods
This study was conducted in parasitology section of microbiology department Teerthanker Mahaveer medical college and research centre, Moradabad, 149 clinical samples were received as per inclusion and exclusion criteria were processed over the period of 11 months from September(2018) to November (2019). Patients with positive for widal, dengue,chikunguniya tests and hepatotoxic or antimalarial drugs taking patients were kept in exclusion criteria. Malaria was diagnosed on finding of parasite on giemsa stain or modified Leishman stained blood peripheral film.
Results
The present study was done for detection of malaria positive cases and to observe the effect of malaria infection kidney function test. In this study total 1317 blood samples of malaria suspected cases were screened for malaria test in which 149(11.31%) patients were found to be malaria positive by microscopy of peripheral blood smear. Out of 149 patients 80(53.70%) were male and 69(46.30%) were female.
In our study 140(93.95%) patients were found infected with plasmodium vivax, out of which 77(55%) were male and 63(45%) were female and 9(6.04%) patients were found infected with plasmodium falciparum out of which 3(33.33%) were male and 6(66.67%) were female.
Patients of all age group were included in the study and majority of malaria positive cases (29.53%) were found in the age group of 21-30 years. Most of the plasmodium vivaxpositive cases (42) and 6 positive cases of plasmodium falciparum were found in the age group of 11-20 year.
Out of 149 malaria positive patient’s total 64(42.95%) patients were found having abnormal serum Creatinine & blood urea while rest 85(57.05%) patients were having normal serum Creatinine & blood urea. Out of 64 abnormal serum creatinine & blood urea persons 27(42.18%) were male and 37(57.82%) were female.
It was found that out of 140 cases of plasmodium vivax, 59(39.59%) patients were having abnormal serum Creatinine & blood urea and out of 9 cases of plasmodium falciparum 5(3.35%) cases were having abnormal serum Creatinine & blood urea.
In our study, out of 149 malaria positive patients 64(42.95%) patients deranged level of creatinine and urea. Out of 64 deranged cases of creatinine and urea 59(92.18%) cases were of plasmodium vivax and 5(7.82%) cases plasmodium falciparum. Out of 59 deranged cases of creatinine 20(33.90%) cases were plasmodium vivax and 5 (100%) cases P. falciparum and urea 39(66.10%) cases were plasmodium vivax and 5(100%) cases of P. falciparum.
Table 1
Distribution of 1317 malaria supposed patients
|
Gender |
Total patients |
No of positive cases |
% |
No of negative cases |
% |
|
Male |
607 |
80 |
53.70 |
542 |
46.41 |
|
Female |
710 |
69 |
46.30 |
626 |
53.59 |
|
Total |
1317 |
149 |
100 |
1168 |
100 |
Table 1 Shows distribution of 1317 suspected patients in which 607 (46.09%) were male and 710 (53.91%) were female. Among 607 male patients 80 (53.70%) were diagnosed as malaria positive patients and 710 female patients 69 (46.30%) were diagnosed as malaria positive patients.
Table 2
Sex wise distribution of total malaria positive patient
|
Sex |
Malaria positive Cases (n=149) |
% |
|
Male |
80 |
53.70 |
|
Female |
69 |
46.30 |
|
All cases |
149 |
100% |
Table 2 Show distribution of 149 malaria positive patients among them 80 were male and 69 were female.
Table 3
Sex and species wise distribution of malaria positive patients
|
Gender |
P.vivax |
P.falciparum |
Total Positive |
||
|
N |
% |
N |
% |
||
|
Male |
77 |
55 |
3 |
33.33 |
80 |
|
Female |
63 |
45 |
6 |
66.67 |
69 |
|
Total |
140 |
100 |
9 |
100 |
149 |
Table 3 Shows sex and species wise distribution of total 149 malaria positive patients. Out of 149 patients study 140 (93.95%) patients were found infected with plasmodium vivax, out of which 77 (55%) were male and 63(45%) were female. 9 (6.05%) patients were found infected with plasmodium falciparum, outof which 3 (33.33%) were male and 6 (66.67%) were female.
So, majority of the patients (93.95%) were found infected with plasmodium vivax.
Table 4
Age wise and species wise distribution of all malaria positive cases
Table 4 Shows that majority of the malaria positive patients were found in the age group of 21-30 year (29.53%). 100% Patients of the age group 11-20 were affected by plasmodium vivax followed by the age group of 11-20 year (30.39%) and 21-30 year (19.60%). Most cases of plasmodium falciparum were reported in the age group of age 21-30year (22.22%) and 11-20 year (66.67%).
Table 5
Species wise distribution with abnormal level of KFT marker of positive cases.
|
KFT marker |
P.V (n=59) |
P.F(n=5) |
Total (n=64) |
|||
|
No |
% |
No |
% |
No |
% |
|
|
Serum creatinine |
20 |
33.90 |
5 |
100 |
25 |
39.06 |
|
Blood urea |
39 |
66.10 |
5 |
100 |
44 |
68.75 |
Table 5 Shows that out of 64 malaria positive patients 25 (39.06%)patientsabnormallevel of total creatinine. 44 (68.75%) patientsabnormal level of total urea.
Discussion
In our countries approximately 216 million cases human when suffering from the malaria cases each every years in all age group in the world but approximately one million deaths and which75% deaths caused by the P.falciparum species. Most cases found in the South Africa of malarial parasites.10
In my study total 1317 malarial suspect patient cases were taken out of 149(11.31%) cases was diagnose as malaria positive cases under the microscopy. Rubina nuqvi et al. in 2015 observed in their study total 5623 patients taken in which 671(11.93%) were positive for malarial infection, in contrast Nitesh Chandra Toshan et al. in 2016 in their study showing out of 19053 fever cases screened for malaria, 509(2.67%) cases were formed positive for malaria.11 In my study, out of 149 patients 80(53.70%) were male and 69(46.30%) be female where the study carried out of through Padhi RK. et al. (2013) result 60(55%) male positive cases and 48(44%) female patients which out of total 108 patients.12 In my study, more percentage of malaria cases were attributable to Plasmodia vivax (93.95%) than P.falciparum (6.04%) as of high wide spread infection of vivax in this region. contrast Milind Y Nadkar et al. (2012) in their study showing out of 711 patients with severe malaria of which 488(68.5%) patients had severe vivax and 223(31.2%) had strict falciparum malarial infection. 13 In our study 149 malaria suspected cases a full 64(4.8%) patients were create have kidney functioning test disturbed while similar study Sandra mariel martin et al. In 2013 observed in their study total 1496 patients taken in which 66(4.4%) patients were found having acute kidney injury. 14 In our study 64 abnormal serum creatinine and blood urea 27(42.18%) were male and 37(57.18%) be female and 92.18% case of Plasmodia vivax and 7.81% case of Plasmodia falciparum have unbalanced, in contrast chavan MS at al. 2017 in their learn out of 119 diagnosed cases of malaria, which 66(73.33%) cases acute kidney in injury in P.falciparumand out of 8(8.87%) were found of acute kidney injury in P.vivax. 1 In out of 64 deranged case of p.vivax creatinine level was found increased level into 39.06% cases in our study while similar study Rajesh Kumar Padhi et al. Out of 55 cases (50.9%) which have renal involvement in the form proteinuria increased serum creatinine in contrast Shubhanker Mitra et al. 2015.15 In our study show an important increase in the serum creatinine and blood urea level in adults with strict malaria infection when compared from the group that had mild malaria infection and manage group.16
Conclusion
In my study it differentiates male and female positive patients of malaria and its two categorises, confirmed malarial patients according to species.
This study shows that the chances of malarial infection are more in men (49%) as compare to women. Plasmodium vivax (55%) affects more people as compared to plasmodium falciparum (6.04%) in this province.
In this study we found that 21-30-year age group (30.0%) are infected more by malaria parasite followed by the 11-20-year age group (24.83%) and 31-40-year age group (10.73%).
42.95% malarial cases were found having abnormal KFT and majority of them were female (57.81%), it implies female are more affected with malaria having abnormal kidney function test.
Serum creatinine level was found raised up to 9.0mg/dl in cases of plasmodium vivax infections. Higher creatinine value may be due to muscular dystrophy paralysis.
It was also noticed that 66.66% positive patients of the falciparum malaria have abnormal KFT.
Hence, it was noted that renal dysfunction occurs more in P.falciparum malaria than P. vivax malaria.
In our study (68.75%) of the patients were found having increased blood urea is the clear evident of deterioration of renal dysfunction in malarial infected patients.
Association between serum creatinine and blood urea derangement is also linked in this study.
Hence, we recommend that such type of study having a large sample size and early diagnosed of malaria infection should be performed with serum creatinine and blood urea test in order to improve diagnosis and prognosis of the disease.
Article DOI
