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Overview :
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
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Laboratory Findings
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Severe Malaria
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Fulminant Hepatitis
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liver function tests
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normal to mildly elevated
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markedly elevated early, then falls to normal with the loss
of liver
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PT and PTT
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normal
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markedly elevated
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platelet count
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thrombocytopenia
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normal
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hemoglobin
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moderate anemia
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normal to mild anemia
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WBC count
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normal
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elevated
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serum creatinine
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elevated
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normal
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splenic size
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normal to marked splenomegaly
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normal
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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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