International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2013): 6.14 | Impact Factor (2013): 4.438 Volume 4 Issue 4, April 2015 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Assessment of Abnormal Liver Chemistry in Malaria & Dengue Infections Anurag Choudhury 1 , Asaranti Kar 2 , Dipanweeta Routray 3 , Bidyut Prava Das 4 1 Department of Pathology & Community Medicine, S.C.B Medical College, Cuttack, Odisha-753007, India 2 Associate Professor, Pathology, S.C.B. Medical College, Cuttack, India Abstract: Background : Malaria and dengue are the two most common mosquito-borne diseases in tropical region including India. Although the routine diagnostic procedure does not involve assessing liver chemistry in above diseases, morbidity and mortality are mostly due to complications arising from long standing liver dysfunctions. Liver function tests (LFT) are designed to assess if there is any hepatic dysfunction or not. Hence using LFT as screening test will help the physician to prevent mortality from liver diseases. Hence, we have conducted this study to demonstrate liver is affected in malaria & dengue infections & analyze the biochemical pattern of liver function in patients diagnosed with malaria and dengue infections. Materials and methods : It is a prospective study carried out in the Department of Pathology, S.C.B. Medical College, Cuttack. Blood samples were collected from patients advised for LFT. The reports were compiled and analyzed using SPSS 21.0 software and then correlated with clinical diagnosis. Results : LFT was done in 533 blood samples out of which non-hepatic infections constituted 154 cases including 64 cases of dengue, 54 cases of tuberculosis & 36 cases of malaria with 98.4% , 57.4% & 77.7% of abnormal LFT results respectively. On comparing the results of dengue and malaria cases with the control, a significant difference (p < 0.005) was obtained for different parameters of LFT. Conclusion : Liver is affected in non-hepatic infections like dengue and malaria; therefore LFT should be performed as a screening test to know the functional status of liver for better management of patients. Keywords: Dengue, Liver function test (LFT), Malaria 1. Introduction Malaria and dengue are the two most common vector-borne diseases prevalent in tropics and subtropics. Being major public health problem malaria is responsible for presenting 300 to 500 million cases of clinical disease per year with 1.5- 2.7 million deaths annually according to WHO, 2000 1 . On the other hand dengue infections affect approximately 100 million people across the tropical world. 2 Despite improvement in diagnostic procedures and WHO eradication programmes, 40% of world’s population still lives in malaria endemic areas. 1 Recently, dengue has emerged as a major recurring health problem with a frequency of 2-3 epidemics per annum occurring mostly around monsoon periods. 2,3 Liver is a vital organ in humans which can function normally in presence of only 25% of liver parenchyma. Therefore liver dysfunction is usually masked unless clinical manifestations appear. Liver function tests (LFT) are a group of serological and biochemical assay designed to screen symptomatic and asymptomatic liver dysfunction. 4 Though LFT are said to be less sensitive and less specific for a particular disease but taken as a panel including patient’s history and clinical examination, both sensitivity and specificity increase. 4 LFT includes assessing several serum parameters like bilirubin, aminotransferases (AST & ALT), alkaline phosphatase (ALP). Malaria is caused by a species of Plasmodium of which infection by P. falciparum appears to be most fatal. 5 The exoerythrocytic sporozoites invade the hepatocytes where they multiply and then release out by killing the hepatocytes to invade other hepatocytes and erythrocytes. 1,6,7 The rise in serum liver enzymes may be due to direct release of enzymes from hepatocytes after parasitic killing or due to leakage from hepatocytes as a result of compromise in membrane integrity due to autoimmune progress or abnormal activation of cells induced by parasites. 1,6 Hyperbilirubinemia is a common feature of falciparum malaria caused by hemolysis of RBCs and partly due to liver damage. 7 Although liver is not a major target organ in dengue as in case of malaria, hepatic dysfunction is a well-recognized feature of dengue infection and changes like centrilobular necrosis, Kupffer cell hyperplasia, monocytic infiltration have been reported. 2,8 Abnormal liver functions with dengue infections might be due to various pathways. Some studies state it might be due to direct attack by virus on hepatocytes, 3, 9 while others impart an immunological pathophysiology. The replication of virus in hepatocytes can be detected by presence of immunoreactive NS3 antigens and upregulations of TRAIL, a type-II transmembrane protein responsible for apoptosis of hepatocytes. 10 Hence analysis of LFT will provide a clue whether liver is affected in malaria and dengue infections and also can indicate the degree of damage to liver thereby helping physicians in proper management of such cases. 2. Materials and Methods This research project was conducted in the Department of Pathology, S.C.B Medical College, Cuttack. Blood samples were collected from patients coming from different wards for investigations of LFT. All the parameters of liver function test were assessed by using an auto-analyzer machine and the reports were collected. Detail clinical history and clinical findings of all the patients were collected. These findings were correlated with that of liver functions tests. Paper ID: 18041508 2412