International Journal of Contemporary Pediatrics | March-April 2018 | Vol 5 | Issue 2 Page 547 International Journal of Contemporary Pediatrics Mannu A et al. Int J Contemp Pediatr. 2018 Mar;5(2):547-551 http://www.ijpediatrics.com pISSN 2349-3283 | eISSN 2349-3291 Original Research Article Hepatic dysfunction in children with complicated malaria Alexander Mannu 1 *, Sunil Kumar Agarwalla 2 , Jaishree Vasudevan 3 , Kathir Subramaniam T. 1 , Ahamed Basha A. 4 INTRODUCTION Malaria is one of the life-threatening diseases across the globe. Nearly half of the world's populations are under threat for malarial infection. In the year 2015, the morbidity and mortality rates of malaria were around 214 million and 5 lakhs respectively. 1 According to the World Malaria Report 2016, India accounted for 89% of the total patients in the South East Asia Region of WHO. Among them, Plasmodium falciparum accounts for more than 50% of the total malaria patients. Majority of the affected individuals are from Eastern part of India, especially from Odisha which accounts for 25% of total reported annual malarial incidence. 2 Among the various species of Plasmodium, P. falciparum is responsible for 30% of malarial deaths in India. 3 Children are the most 1 Department of Pediatrics, Chettinad Hospital and Research institute, Tamil Nadu, India 2 Department of Pediatrics, Maharaja Krishna Chandra Gajapati Medical College and Hospital, Berhampur, Odisha, India 3 Department of Pediatrics, Shri Sathya Sai Medical College and Research Institute, Tamil Nadu, India 4 Department of Physiology, Chettinad Hospital and Research institute, Tamil Nadu, India Received: 23 December 2017 Accepted: 30 January 2018 *Correspondence: Dr. Alexander Mannu, E-mail: paedsalex@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Complicated malaria caused by Plasmodium falciparum alone or with P. vivax can lead to multi organ dysfunction. There is a paucity of studies about hepatic dysfunction in children with complicated malaria. Hence, this retrospective study was done to find out the clinico-biochemical profile of children with complicated malarial hepatic dysfunction from a malaria endemic region of India. Further, liver function test (LFT) response to Artemisinin-based combination therapy (ACT) i.e. artesunate + sulfadoxine-pyrimethamine therapy in the malarial hepatic dysfunction children was assessed. Methods: Out of 203 children confirmed to have malaria, 60 children were found to have complicated malaria with jaundice as per WHO malaria guidelines (total serum bilirubin >3 mg%). Physical examination, malaria related biochemical and ultra-sonographic findings were noted. All the children were found to be uniformly on ACT as per institute protocol adapted from WHO guidelines. Biochemical parameters of hepatic function were compared between day 1 and 4. Results: Presentations were fever, pallor and clinical jaundice in 100%, reddish urine in 63.3%, tender hepatomegaly in 100% and splenomegaly in 81.7% of the study population. Liver function test showed mild to moderate elevation of serum bilirubin and enzymes with remarkable recovery noticed with the use of ACT in all the study subjects. Conclusions: Clinical presentations of malarial hepatic dysfunction although mimics viral hepatitis, LFT showed mild to moderate elevation only. Further, ACT therapy was found effective in the management of all children with hepatic dysfunction in complicated malaria. Keywords: ACT, Children, Complicated malaria, LFT, Hepatic dysfunction DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20180552