107 Document heading doi:10.1016/S2222-1808(12)60026-7 Thrombocytopenia in children with malaria - A study from coastal Karnataka, India Guruprasada Shetty, K Shreedhara Avabratha * , Seema Gonsalves, Aby Dany, B Sanjeev Rai Department of Pediatrics, Father Muller Medical College Mangalore Karnataka, India Asian Pacific Journal of Tropical Disease (2012)107-109 Asian Pacific Journal of Tropical Disease journal homepage:www.elsevier.com/locate/apjtd *Corresponding author: Dr. K Shreedhara Avabratha, Associate Professor, Department of Pediatrics, Fr Muller Medical College, Mangalore-575002, Karnataka, India. Tel: 0824-2436301 Fax: 0824-2437402 E-mail: shreedharkdr@gmail.com Founding Project: This work was financially supported by Father Muller Research Centre (Grant No. FMIR/15/2011). 1. Introduction Malaria is endemic in the tropics and subtropics causing 247 million infections worldwide and 3.3 billion world’s population were at risk in 2006 causing nearly a million deaths of which 88% occurred in sub-Saharan African children < 5 years of age. The burden of malaria in Southeast Asia has been underappreciated, despite recent evidence suggesting that the continent contributes almost 40% of the world’s malaria. India contributes 75%-77% of the total malaria in Southeast Asia and about 95% of the population of moderate to high risk of malaria in Southeast Asia Region is living in India [1,2] . It is caused by protozoa parasite of the genus Plasmodium which infects and destroys red blood cells. Four species of plasmodia [ Plasmodium falciparum ( P. falciparum) , Plasmodium malariae, Plasmodium ovale and Plasmodium vivax ( P. vivax) ] cause malaria in humans of which P. falciparum is the most common cause of morbidity and mortality. Malaria parasite affects multiple organs of the body like liver, spleen, brain, gastro intestinal tract, gall bladder, pancreas, blood vessels and placenta. So, the clinical picture could be of wide spectrum ranging from simple malaise to life threatening central nervous system symptoms like coma. Thrombocytopenia has been reported to be associated with malaria, with an incidence ranging from 60%-80%, with some studies reporting a lower incidence in vivax malaria as compared to falciparum malaria [3] . In view of paucity of data in children from Indian studies, we have attempted to correlate the low platelet count and type of malaria. This study was conducted in Mangalore, a picturesque city in southern India, on the shore of the Arabian Sea. Malaria is endemic in this city and has already killed more than 300 people in the past 15 years [4] . 2. Materials and methods This was a retrospective study of medical records of children, admitted to Father Muller Medical College Hospital Mangalore, in costal Karnataka, India, with the diagnosis of malaria. The study period was between January 2010 to June 2011. Inclusion criteria was children <15 years with a diagnosis of malaria. Patients with history or clinical features suggesting chronic liver disease and those with ARTICLE INFO ABSTRACT Article history: Received 15 October 2011 Received in revised form 27 December 2011 Accepted 28 February 2012 Available online 28 April 2012 Keywords: Thrombocytopenia Malaria Severity Plasmodium vivax Plasmodium falciparum Acute febrile illness Objective: To study the occurrence and severity of thrombocytopenia in children with malaria. Methods: It was a retrospective study, done at Fr Muller Medical College Hospital Mangalore, in Karnataka, India. Data regarding all positive cases of malaria < 15 years admitted in the hospital between January 2010 to June 2011 were obtained. Patients were further assessed for thrombocytopenia and its severity. Data were analysed by Chi square test using SPSS version 13.0. Results: A total of 159 cases were included in the study with a mean age of presentation of 9 years. Plasmodium vivax was identified in 106 (66%) patients while Plasmodium falciparum in 26 (16%) and mixed infection in 27 (18%) patients. Thrombocytopenia was observed in 113 (71%) cases, of which 35 (31%) cases had mild, 49 (43%) cases moderate and 29 (26%) cases had severe thrombocytopenia. Thrombocytopenia was equally found in vivax and falciparum infection with no significant difference in severity between vivax and falciparum species. Conclusions: Thrombocytopenia is frequently seen in malaria and it is not dependent on type of malaria. In any acute febrile illness, thrombocytopenia should alert one to the possibility of malaria. Contents lists available at ScienceDirect