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Jaundice is common in falciparum malaria. Most often it is caused
by hemolysis and accordingly there is elevation of unconjugated bilirubin levels.
Hemolysis can also elevate levels of aspartate aminotransferase (SGOT). These findings
alone therefore do not imply severe hepatic dysfunction in malaria. The mild elevation in
serum bilirubin level usually returns to normal within 3-5 days of effective antimalarial
treatment. It does not warrant any special dietary restrictions nor does it require any
treatment by 'traditional methods' (ayurveda etc.).
However, hepatic dysfunction may also be
seen in cases of severe falciparum malaria. Such patients have conjugated
hyperbilirubinemia, marked elevations of aspartate aminotransferase and alanine
aminotransferase and prolongation of prothrombin time. Massive hemolysis, disseminated
intravascular coagulation and hepatic dysfunction may all contribute to this picture. A
term 'malarial hepatitis' has been used to describe this entity but is not well accepted.
Clinical signs of liver failure are never due to malaria and in such cases, other
associated hepatic diseases, like viral hepatitis, should be considered.
See
Pathology
Investigations: Serum bilirubin
and serum transaminases should be done in all cases of falciparum malaria who have icterus
and pallor and who are sick and require admission. Prothrombin time and serum protein
estimation may be also be needed.
Treatment:
[See Treatment of Severe P.
falciparum malaria]
In most patients, the bilirubin and enzyme levels return to normal within days of antimalarial treatment. No
other specific treatment is needed.
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