Malaria is still the major killer in developing countries like India. In recent years respiratory system is being recognized as one of the major manifestations of falciparum malaria. It is very important to recognize that the pulmonary involvement is due to malaria to institute treatment to reduce morbidity and mortality. Our study was to detect the incidence of pulmonary involvement in malaria and its impact on outcome.
Our study included 150 cases of slide positive malaria. Out of these 72(48%) Plasmodium vivax, 54(36%) Plasmodium falciparum and 24(16%) were mixed infections. The patients were thoroughly investigated for involvement of respiratory system. Besides routine hematological and biochemical investigations E.C.G. and chest x-ray were done in all patients. Patients having ARDS and acute pulmonary edema were subjected to echocardiography, haemodynamic monitoring by Swam-Ganz catheter and oxymetry. These patients were treated in ICU with mechanical ventilatory support with high concentration of inspired oxygen and use of Positive End Expiratory Pressure.
Out of 150 cases of malaria 45 patients presented with respiratory symptoms in the form of cough (80%), dyspnoea (40%), expectoration (32%), chest pain (18%) and haemoptysis (4%). The clinical presentations were in the form of bronchitis (23 cases), pneumonia (8cases), acute pulmonary edema (2 cases), ARDS (7 cases), pulmonary tuberculosis (3 cases) and respiratory muscle fatigue (2 cases). Out of the 45 cases with respiratory symptoms 42 (93.4%) had falciparum malaria. Four out of 7 patients of ARDS and both the 2 patients with acute pulmonary edema died.
Malarial atypical respiratory presentations are higher than reported in the literature. P. falciparum malaria is responsible for most of the respiratory manifestations. Acute pulmonary edema and ARDS have high-grade mortality in spite of intensive care.
Patients of high fever with respiratory symptoms should have always blood slide examination for malarial parasites in endemic areas and prompt antimalarial therapy should be started to save life.
Umashankar Mishra, None.