Table 1 Patient details

1

46 y

M

November 2007

High intermittent fever, Body aches, vomiting, diarrhoea of 4 days, 2 cm splenomegaly and tender hepatomegaly 3 cm

Hb-11 g/dL, WBC-4.8 × 10⁹/L N-55%, Platelet 110 × 10⁹/L

ALT-110 iu/L, AST-140 iu/L

P. vivax Parasite count 3760/μL

Chloroquine Premaquine

None

2

18 y

M

April 2008

High intermittent fever, severe headache, vomiting, 4 days; progressed to confusion, rigidity over 24 hours, 3 cm hepatomegaly

Hb-10 g/dL, WBC-5.6 × 10⁹/L, N-64%, Platelet 158 × 10⁹/L

ALT-90 iu/L AST-58 iu/LB. Urea: 65 mg/dL

P. malariae and P falciparum parasite count 26,000/μL

iv Quinine + Doxycycline+ Co artum + Premaquine

Johannesburg South Africa

3

33 y

M

1^st admission: December 2009

Shortness of breath on exertion, lethargy for one month, sever pallor, 6 cm Splenomegaly

Hb- 5.5 g/dL, WBC 6.2 × 10⁹/L, Platelets-230 × 10⁹/L, Basophilic stippling in red cells

ALT- 56 iu/L, AST-110 iu/L, Serum Pb > 65 mg/dL

Malaria parasite nil. Malaria Ag negative

Penicilamine

Uganda

M

2^nd admission: January 2010

High intermittent fever, sever pallor, ill and toxic, 8 cm Splenomegaly and 4 cm hepatomegaly

Hb-6.5 g/dL, WBC-2.2 × 10⁹/L, Platelets-65 × 10⁹/L, Retic count-5% Bone marrow biopsy: normal

SGOT-100 iu/l, SGPT-248 iu/L S.Bilirubin-normal S.Protein-5.1 g/dl, Alb-3.7 g/dl, Glob-1.3 g/dl γGT-69.2 iu/L PT & INR-1.14

P. falciparum Parasite count 3550/μL

Iv Quinine + Co artum + Premaquine

4

35 y

M

September-2010

High intermittent fever, mild icterus, body aches, headache, vomiting, 2 cm splenomegaly, 4 cm hepatomegaly

Hb-10.5 g/dL, WBC-2.8 × 10⁹/L, Platelets-45 × 10⁹/L,

ALT-430 iu/L, AST-560 iu/L, S.Bil 3.4 mg/dl B. Urea: 98 mg/dL

P. vivax + ve (serology for Dengue leptospira, Viral hepatitis A, B, C, E negative)

Chloroquine + Premaquine

Kolkata India

5

28 y

M

October 2010

High intermittent fever, mild icterus, body aches, headache, vomiting, 4 cm splenomegaly, 3 cm tender hepatomegaly

Hb-11.5 g/dL, WBC-6.2 × 10⁹/L, Platelets-35 × 10⁹/L,

ALT-630 iu/L, AST-1054 iu/L, Serum Bilirubin 2.4 mg/dl B. Urea: 45 mg/dL