Clinical spectrum and outcome of children presented with different malarial species in Karachi, Pakistan

Objective: We aimed this study to compare spectrum of clinical presentation, hospital course and outcome of children diagnosed with different malarial species. Methods: This descriptive cross sectional study was conducted from January 2008 to December 2010 in children age between 1 to 14 years, admitted in Pediatric Ward of Civil Hospital, Karachi with diagnosis of malaria by peripheral smear or immune chromatography. Bio-data, clinical presentation, and outcome were recorded. All children received supportive and anti-malarial treatment. Results: Out of 2357 children visited the emergency department, malarial parasitemia were positive in 400. Two third (65.2%) had plasmodium falciparum infection. In falciparum group, the common age of presentation was <5 years (70%), intermittent fever was found in 90.4%; jaundice in 21.8%, visceromegaly in 62%, thrombocytopenia in 61%, while neurological presentation in 11.5% cases. 16 children (6.1%) died due to malarial complications. 114 children (28.5%) were found to have plasmodium vivax parasitemia (P.v). In patients with vivax, the common age of presentation was <5 years (69%), intermittent fever was present in 86.8%; jaundice in 20.2%, and thrombocytopenia in 70%. Overall 25 (6.2%) children were diagnosed as having mixed infection for both falciparum and vivax. In this group jaundice was in 52% cases, splenomegaly in all children. The mortality rate in mixed infection was high compared to falciparum and vivax group (p-0.04). Conclusion: It was obvious from this study that malaria can present in multiple ways with similar presentations to other diseases and can mislead the diagnosis. Fever, visceromegaly and thrombocytopenia were most common presentations. Mixed infection carried a higher mortality.