Clinical and Hematological Criteria For Malaria Diagnosis In Endemic Area  with Limited Resources

Shahnawaz Zafar; Rao Saad Ali Khan; Ali Raza Jaffri; Syed Arif Raza Zaidi; Mohammad Noman Karim; Mubasher Shaukat

doi:10.51253/pafmj.v75iSUPPL-5.8334

Authors

Shahnawaz Zafar Department of General Medicine, Combined Military Hospital Chhor /National University of Medical Sciences (NUMS) Pakistan
Rao Saad Ali Khan Department of Gastroenterology, Combined Military Hospital Malir /National University of Medical Sciences (NUMS) Pakistan
Ali Raza Jaffri Department of Pediatric Medicine, Combined Military Hospital Chhor /National University of Medical Sciences (NUMS) Pakistan
Syed Arif Raza Zaidi Department of General Medicine, Combined Military Hospital Chhor /National University of Medical Sciences (NUMS) Pakistan
Mohammad Noman Karim Department of Otorhinolaryngology, Combined Military Hospital Chhor /National University of Medical Sciences (NUMS) Pakistan
Mubasher Shaukat Department of Otorhinolaryngology, Hull University teaching hospitals, United Kingdom

DOI:

https://doi.org/10.51253/pafmj.v75iSUPPL-5.8334

Keywords:

Clinical score, criteria, endemic, Malaria

Abstract

Objective: To devise a clinical and hematological criteria for malaria diagnosis in endemic area with limited resources

Study Design: Prospective longitudinal study

Place and Duration of Study: Combined military hospital Chhor, Sindh Pakistan from Feb 2021-Jan 2022.

Methodology: 164 patients were enrolled using inclusion and exclusion criteria. Based on past experiences and unpublished data, specific clinical parameters of malaria were identified and given a score. Maximum score was 12. Clinical Score was calculated and verified for each patient by two clinicians. Later all the patients were subjected to Immuno-chromatographic tests by trained person to diagnose malaria. Clinical Score was then compared with subsequent ICT diagnosis of malaria. Cut-off was marked at score 7 as 151(92.7%) of patients presenting at and above this cut-off were confirmed cases of malaria.

Results: 164 fever cases were included in the study. Out of 164 cases, 143 males (87.02%) and rest 21 females (12.08%). Mean clinical score was 9 ± 2. Mean age of patients were 28 ± 6 years. 151(92.7%) cases presented at score ≥ 7.

Conclusion: Score ≥ seven be used in clinics of endemic area to assign cases suffering from malaria with confidence and can be treated empirically. This criteria can substitute ICT however cannot replace it. This criteria is very helpful where labs are not freely available or cannot be relied upon due to problems, specifically in peripheral health centre with limited resources.

Downloads

Download data is not yet available.

References

1. Varo R, Chaccour C, Bassat Q. Update on malaria. Med Clin (Barc). 2020 Nov 13; 155(9): 395-402.

2. Moxon CA, Gibbins MP, McGuinness D, Milner DA Jr, Marti M. New Insights into Malaria Pathogenesis. Annu Rev Pathol. 2020 Jan 24; 15: 315-343.

3. Ahmadal-Agroudi M, El-Mawla Megahed LA, Abdallah EM, Morsy TA. A MINI OVERVIEW OF MALARIA IN PREGNANCY. J Egypt Soc Parasitol. 2017 Apr; 47(1): 177-196.

4. Varo R, Balanza N, Mayor A, Bassat Q. Diagnosis of clinical malaria in endemic settings. Expert Rev Anti Infect Ther. 2021 Jan; 19(1): 79-92.

5. Khattak AA, Venkatesan M, Nadeem MF, et al. Prevalence and distribution of human Plasmodium infection in Pakistan.Malar J. 2013; 12: 297.WHO malaria report 2021

6. Nkenfou CN, Hell VN, Georges NT, Ngoufack MN, Nkenfou CN, Kamgaing N, Ndjolo A. USAGE OF A RAPID DIAGNOSTIC TEST FOR MALARIA IN CHILDREN. Afr J Infect Dis. 2018 Dec 12; 13(1): 24-31.

7. D. S. Tarimo, J. N. Minjas & I. C. Bygbjerg (2001) Malaria diagnosis and treatment under the strategy of the integrated management of childhood illness (IMCI): relevance of laboratory support from the rapid immunochromatographic tests of ICT Malaria P.f/P.v and OptiMal,Annals of Tropical Medicine & Parasitology,95:5,437-444

8. Houzé S. Les tests de diagnostic rapide pour le paludisme [Rapid diagnostic test for malaria]. Bull Soc Pathol Exot. 2017; 110(1): 49-54.

9. Olaleye BO, Williams LA, D'Alessandro U, Weber MM, Mulholland K, Okorie C, Langerock P, Bennett S, Greenwood BM. Clinical predictors of malaria in Gambian children with fever or a history of fever. Trans R Soc Trop Med Hyg. 1998; 92(3): 300-4

10. Bojang KA, Obaro S, Morison LA, Greenwood BM. A prospective evaluation of a clinical algorithm for the diagnosis of malaria in Gambian children. Trop Med Int Health. 2000; 5(4): 231-6

11. Pakistan Malaria Annual report 2019.

12. World malaria report 2021

13. Qureshi, N.A., Fatima, H., Afzal, M.et al.Occurrence and seasonal variation of human Plasmodium infection in Punjab Province, Pakistan.BMC Infect Dis 19, 935 (2019).

14. Jahan F, Khan NH, Wahid S, Ullah Z, Kausar A, Ali N. Malaria epidemiology and comparative reliability of diagnostic tools in Bannu; an endemic malaria focus in south of Khyber Pakhtunkhwa, Pakistan. Pathog Glob Health. 2019; 113(2): 75-85.

15. Ranadive N, Kunene S, Darteh S, Ntshalintshali N, Nhlabathi N, Dlamini N, Chitundu S, Saini M, Murphy M, Soble A, Schwartz A, Greenhouse B, Hsiang MS. Limitations of Rapid Diagnostic Testing in Patients with Suspected Malaria: A Diagnostic Accuracy Evaluation from Swaziland, a Low-Endemicity Country Aiming for Malaria Elimination. Clin Infect Dis. 2017; 64(9): 1221-1227.

16. Mbanefo A, Kumar N. Evaluation of Malaria Diagnostic Methods as a Key for Successful Control and Elimination Programs. Trop Med Infect Dis. 2020; 5(2): 102.

17. Raza A, Ghanchi NK, Khan MS, Beg MA. Prevalence of drug resistance associated mutations in Plasmodium vivax against sulphadoxine-pyrimethamine in southern Pakistan. Malar J. 2013; 12: 261.

18. Kamp TJ, Hamdan MH, January CT. Chloroquine or Hydroxychloroquine for COVID-19: Is Cardiotoxicity a Concern? J Am Heart Assoc. 2020; 9(12): e016887.

https://doi: 10.1161/JAHA.120.016887

19. Mutanda, A.L., Cheruiyot, P., Hodges, J.S. et al. Sensitivity of fever for diagnosis of clinical malaria in a Kenyan area of unstable, low malaria transmission. Malar J 13, 163 (2014)

20. van Eijk AM, Mannan AS, Sullivan SA, Carlton JM. Defining symptoms of malaria in India in an era of asymptomatic infections. Malar J. 2020; 19(1): 237.

21. Tabue RN, Njeambosay BA, Zeukeng F, et al. Case Definitions of Clinical Malaria in Children from Three Health Districts in the North Region of Cameroon. Biomed Res Int. 2019; 2019: 9709013

22. Tariq Mahmood, Sajid Maqbool, Rashid Mahmood Malaria as a cause of acute fever without localizing signs (AFWLS) in children,Pak Paed J Mar 1999; 23(1): 9-11.

23. Plucinski MM, Candrinho B, Dimene M, Smith T, Thwing J, Colborn J, Rogier E, Zulliger R. Estimation of Malaria-Attributable Fever in Malaria Test-Positive Febrile Outpatients in Three Provinces of Mozambique, 2018. Am J Trop Med Hyg. 2020; 102(1): 151-155.

24. Iqbal Haider, Muhammad Saleem, Fazli Subhan, Imran Khan, Iftikhar Muhammad, Aliena Badshah.Clinical presentation and outcome of 100 cases of falciparum malaria,Khyber Med Uni Med J Apr - Jun 2012; 4(2): 59-63.

25. shah V, .K.Shah B, Vadera B, .K.Acharya H. Clinical Scoring System to Predict Malarial Fever: A Prospective Study. International Journal of Medicine and Public Health. 2011; 1(2): 30-33