Study on specic species of malaria in relation to haematological changes

Background: As malaria is a potential medical emergency, prompt and accurate diagnosis is critical for its effective management. Conventional microscopic examination of peripheral thick and thin blood smear examination remains the “gold standard” for malaria diagnosis. Material: A 2 year prospective study from 2011 to 2013 was conducted at Navodaya Medical College Hospital and Research Centre, Raichur. The study comprised of a total number of 150 cases positive for Malaria, collected from above mentioned centre and those referred from peripheral referral centres. Clinical history regarding age, sex, nature and duration of illness were elicited. Blood sample for haematological study was taken before starting anti-malarial drugs in all these cases. Result: Out of total cases, P. vivax infected cases (62%) were common than P. falciparum (34%) and mixed infection cases [PV & PF] (4%). Most common presenting symptom of cases affected by PV, PF and mixed infection were fever and chills & rigors and least common symptom was cough. Most important haematological changes observed were anaemia and thrombocytopenia (77.3% each) and leucopenia (31.3%). All the above mentioned changes in haematological parameters were species specific and statistically significant, except for red cell indices, DLC and ESR. Conclusions: In conclusion, changes in haematological profile can help in early diagnosis of specific species of malaria for timely and appropriate treatment that can reduce the severity and prevention of additional consequences.


Introduction
Mainly affected due to malaria infection are children, pregnant women (particularly primigravidae) and non immune people (e.g., travellers, foreign workers). However, all age groups may be at risk of severe disease during malaria epidemics, which occur either due to changes in the physical environment ( As malaria is a potential medical emergency, prompt and accurate diagnosis is critical for its effective management. Conventional microscopic examination of peripheral thick and thin blood smear examination remains the "gold standard" for malaria diagnosis, which provides the most comprehensive information on a single test format.
The technique is widely accepted worldwide due to its simplicity, low cost, high specificity and ability to assess parasitic density and variations in haematological parameters can be of great help to support the diagnosis, as the target of malarial parasite is RBC [10][11][12].
Quick and convenient rapid diagnostic tests like fluorescent microscopy (QBC), dipstick antigen detection test (HRP-2 and pLDH based) and PCR assays are currently implemented, but are not cost effective and need improved quality control [10][11][12][13].     33.3%), and few cases (12cases, 8%) also showed raised MCV. There was no significant association statistically.    There was no much species specific variation in eosinophil and monocyte count.  falciparum was the most common species followed by P. vivax and mixed infection.

RBC COUNT:
In this study, low RBC count was seen commonly in P. falciparum infected cases (78.4%) when compared to cases with mixed infections (66.6%) and P. vivax infected cases (53.8%) whereas, high RBC count was seen mostly in P.
vivax (4.3%) than in P. falciparum infected cases (3.9%) with respect to P. vivax and P. falciparum species, and there was a good correlation when compared with the study of Thaker MV et al [19].

ESR:
In the present study, mild rise in ESR was seen most in mixed infection cases (33.3%), followed by P. vivax (31.1%) and P. falciparum infected cases (27.4), moderate rise was common in P. vivax infected cases (51.6%) when compared to mixed infection (50%) and P. falciparum infected cases (45.1%) and severe rise was seen mostly in P.
falciparum infected cases (19.6%) when compared to mixed infections (16.6%) and P. vivax infected cases (8.6%). These findings had a good correlation with the study conducted by Thaker MV et al with respect to P. vivax and P. falciparum infected cases [19].

Study Limitations: Further study in large number
of patients is required to comment regarding changes in haematological profile in early diagnosis of specific species of malaria and further ongoing studies are warranted.

Conclusion
In conclusion, the relationship between haematological parameters and malarial infection, may afford means to improve diagnosis with specific tests and alleviate clinical severity of or accelerate recovery from this disease. Changes in haematological profile can help in early diagnosis of specific species of malaria for timely and appropriate treatment that can reduce the severity and prevention of additional consequences.
What does the study add to the existing knowledge?
Literature on changes in haematological profile of specific species of malaria has shown almost neglects other important of specific species early diagnosis and treatment which makes meaningful adding in existing literature by conducting our study to timely recognition and understanding of vital to know and perform hematological investigation to detect early complications and to treat them effectively.

Dr. Anand A S: Manuscript preparation
Dr. Sagar Mhetre: Statistical analysis