Malaria: an underdiagnosed and often neglected medical emergency

A Rare Case Report of Fatal Fulminant Hepatic Failure in a Child due to Mixed vivax and falciparum Infection

Malaria remains an overwhelming problem in the tropical developing countries, with 300 to 500 million new cases and about a million deaths per year (Mishra et al., 2003). Malaria is a potentially life-threatening disease in the tropics. Jaundice is one of the severe manifestations of falciparum malaria. Its incidence (Mishra et al., 2003). varies between 10 and 45% in different reports and is seen more in adults than in children. Jaundice may vary from mild to very severe. However, clinical signs of hepatic encephalopathy (such as liver flaps) are never seen unless there is presence of concomitant viral hepatitis (WHO, 2000). Our case is a 6-year-old female child presented with fever, jaundice, and anasarca. Peripheral smear showed trophozoites and schizonts of Plasmodium (P.) vivax and trophozoites and gametocytes of P. falciparum. Viral markers for hepatitis were negative. She developed fulminant hepatic failure and expired after 26 hours of admission.

Jaundice in malaria

Jaundice is not an unusual accompaniment of malaria. It can occur due to intravascular hemolysis, disseminated intravascular coagulation, and, rarely, 'malarial hepatitis'. Although the primary schizogony of the malarial parasite always leads to the rupture of the infected hepatocyte, alteration of the hepatic functions is uncommonly recorded due to this event. Histologically, the hepatitis or the actual inflammation in the liver has never been demonstrated. Nonetheless, the term 'malarial hepatitis' (MH) has been used in the literature to describe the occurrence of hepatocellular jaundice in patients with Plasmodium falciparum infection. The authors' own data and review of the literature indicate that it is not an uncommon entity. In endemic areas, jaundice is seen in approximately 2.5% of patients with falciparum malaria. It also appears to be a heterogeneous syndrome and one can recognize two clinical subsets. In one group there was an acute, virulent presentation with coma, renal failure and in some cases even hemorrhagic manifestations. It is only in this setting that jaundice signified a 'severe' disease as noted by the World Health Organization action program. This presentation is often confused with acute viral hepatitis and acute hepatic failure in non-endemic areas, but can be clinically differentiated.

Progress in the research of artemisinin-related antimalarials: an update

Artemisinin, a sesquiterpene lactone endoperoxide isolated from Artemisia annua L., and a number of its semisynthetic derivatives have shown to possess antimalarial properties. They are all effective against Plasmodium parasites that are resistant to the newest and commonly used antimalarial drugs. This article gives a survey of the literature dealing with artemisinin-related antimalarial issues that have appeared from the end of 1989 up to the beginning of 1994. A broad range of medical and pharmaceutical disciplines is covered, including phytochemical aspects like the selection of high-producing plants, analytical procedures, and plant biotechnology. Furthermore, the organic synthesis of artemisinin derivatives is discussed, as well as their mechanism of action and antimalarial activity, metabolism and pharmacokinetics, clinical studies, side-effects and toxicology, and biological activities other than antimalarial activity.