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Distinction of Severe Falciparum Malaria from Fulminant Hepatic Failure

Purpose: To distinguish severe malaria from fulminant hepatitis in a patient presenting with jaundice and altered consciousness.

Description

A patient with severe Plasmodium falciparum malaria may clinically present with findings suggestive of fulminant hepatitis. Devarbhavi et al list features which can help distinguish these two conditions. The authors are from St. John's Medical College Hospital in Bangalore, India, and the Mayo Clinic.


 

Severe malaria and fulminant hepatitis may both present with:

(1) altered consciousness

(2) jaundice with elevated serum total bilirubin

Laboratory Findings

Severe Malaria

Fulminant Hepatitis

liver function tests

normal to mildly elevated

markedly elevated early, then falls to normal with the loss of liver

PT and PTT

normal

markedly elevated

platelet count

thrombocytopenia

normal

hemoglobin

moderate anemia

normal to mild anemia

WBC count

normal

elevated

serum creatinine

elevated

normal

splenic size

normal to marked splenomegaly

normal

 

Useful features which should suggest severe malaria:

(1) hepatomegaly (usually liver is small to normal in fulminant hepatitis)

(2) normal prothrombn time (PT)

(3) presence of malaria in the peripheral blood smear

 

Fulminant hepatitis is a progressive disease, with survival dependent on liver transplantation. Severe malaria may respond to antimalarial therapy.

 

Limitations:

• There is nothing to prevent a patient from having both severe malaria and fulminant hepatitis. However, this would be uncommon. The presence of malarial parasites should cause reconsideration of a diagnosis of fulminant hepatitis.

 


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Specialty

Objective

ICD-10