Correlation of bilirubin with liver enzymes in patients of falciparum malaria

Falciparum malaria is responsible for 1-3 million deaths annually worldwide. Liver involvement is common and may manifest as raised serum bilirubin, hepatomegaly and elevated liver enzymes. Unconjugated hyperbilirubinemia is usually seen leading to increased mortality. Alanine aminotransferase [SGPT] is a marker of liver damage. The present study was conducted on Plasmodium falciparum malarial patients to observe the correlation between liver enzymes and bilirubin. To observe the correlation coefficient of bilirubin with liver enzymes [SGPT, SGOT and Alkaline Phosphatase] in patients of falciparum malaria. A Descriptive study. Department of Biochemistry, Basic Medical Sciences Institute, JPMC, Karachi from August 2005 to July 2006. Total 81 patients of different ages and both sexes suffering from acute malaria, were selected by convenient sampling. Nine patients, infected by Hepatitis B and C infections were excluded from the study. Among remaining 72 cases, 48 [70%] were suffering from infection by Plasmodium falciparum and 24 [30%] from infection by Plasmodium vivax infection. The Falciparum infected patients were equally divided into two groups on the basis of duration of illness. Group I having 1- 7days illness and Group II having duration of 8-20 days. Patients suffering from plasmodium vivax infection and illness of 1 - 20 days were placed in Group III. In the group I, SGPT and Alkaline phosphatase showed a statistically significant positive correlation r=0.50 and r=0.054, respectively with bilirubin [P<0.05]. In group II, the SGPT showed a statistically excellent positive correlation [r=0.88; P<0.01], while the SGOT and Alkaline phosphatase also showed a statistically significant positive correlation. In group III both aminotransferases and Alkaline phosphatase showed a statistically significant positive correlation r=0.82, 0.63 and 0.69 respectively. Positive correlation of liver enzymes and bilirubin shows that liver function tests should be performed along with early diagnosis of Plasmodium falciparum malarial infections in order to prevent complications and to reduce mortality

Serum paraoxonase 1 activity status in patients with liver disorders

Paraoxonase 1 [PON1] is an esterase, exclusively synthesized by liver. The present study has two objectives: to determine the PON1 activity status in various disorders associated with hepatocellular damage and to correlate the changes of PON1 activity with the standard liver function and fasting lipid profile tests in these disorders. The study groups consisted of 95 patients with liver diseases including acute viral hepatitis [14], cirrhosis with portal hypertension [33], leptospirosis [14], sepsis and multi organ failure [15], left ventricular failure [9], and falciparum malaria [10]; and 53 healthy controls. Serum PON1 activity was measured manually using spectrophotometer. Liver function test parameters and fasting lipid profile were performed in clinical chemistry auto analyzer [HITACHI 912]. The serum PON1 activity in patients with acute viral hepatitis and sepsis decreased significantly [P<0.001] and moderately in falciparum malaria [P<0.05]. However, in patients with cirrhosis, leptospirosis and left ventricular patients, its activity did not change significantly. On applying Pearson correlation, serum PON1 activity correlated positively with high-density lipoprotein-cholesterol [HDL-C] in patients with sepsis [r=0.633, P<0.05], left ventricular failure patients [r=0.814, P<0.05] and negatively with acute viral hepatitis patients [r=-0.528, P<0.05]. PON1 activity has decreased significantly in acute viral hepatitis, sepsis with multi organ failure and falciparum malaria patients. Determination of PON1 activity may serve as a useful additional test in assessing these conditions

Associação de metemoglobinemia e deficiência de glicose-6-fosfato desidrogenase em pacientes com malária tratados com primaquina / Association of methemoglobinemia and glucose-6-phosphate dehydrogenase deficiency in malaria patients treated with primaquine

Este estudo teve como objetivo verificar a ocorrência de metemoglobinemia em indivíduos deficientes da glicose-6-fosfato desidrogenase durante o tratamento da infecção malárica com primaquina. Foram selecionados pacientes com diagnóstico para malária por Plasmodium vivax ou mista V+F (Plasmodium vivax + Plasmodium falciparum), Grupo 1: com 74 indivíduos com diagnóstico clínico de metemoglobinemia e Grupo 2: 161 indivíduos sem diagnóstico clínico de metemoglobinemia. Quanto à deficiência da G6PD, nos Grupos 1 e 2, houveram 51,3 por cento (38) e 8,7 por cento (14) de indivíduos enzimopênicos, respectivamente, demonstrando através de tais dados, significância estatística na associação com a metemoglobinemia somente nos indivíduos do Grupo 1 (p<0,05). A comparação da relação da metemoglobinemia à deficiência da G6PD mostrou haver uma possível associação de indivíduos enzimopênicos desenvolverem metemoglobinemia com maior freqüência.

This study had the aim of investigating occurrences of methemoglobinemia among individuals with glucose-6-phosphate dehydrogenase deficiency during treatment for malaria infection using primaquine. Patients with a diagnosis of malaria caused by Plasmodium vivax or the V+F mixture (Plasmodium vivax + Plasmodium falciparum) were selected. Group 1 consisted of 74 individuals with a clinical diagnosis of methemoglobinemia and Group 2 consisted of 161 individuals without a clinical diagnosis of methemoglobinemia. The glucose-6-phosphate dehydrogenase deficiency rates (numbers of enzymopenic individuals) in Groups 1 and 2 were 51.3 percent (38) and 8.7 percent (14) respectively. These data demonstrated a statistically significant association with methemoglobinemia only among the individuals in Group 1 (p<0.05). Investigation of the relationship between methemoglobinemia and glucose-6-phosphate dehydrogenase deficiency showed that there was a possible association such that enzymopenic individuals may develop methemoglobinemia more frequently.

Characterization of Plasmodium falciparum glutamate dehydrogenase-soluble antigen

The major aim of this study was to characterize a soluble Plasmodium falciparum antigen from the plasma of malaria-infected humans and Plasmodium falciparum culture supernatants, using immunoabsorbent techniques and Western blotting. An Mr 60-kDa protein was isolated from the plasma of patients with Plasmodium falciparum malaria by affinity chromatography using rabbit anti-Proteus spp GDH(NADP+) serum as ligand. This protein, present in plasma of patients with acute Plasmodium falciparum infection, in Plasmodium falciparum culture supernatants, and in immune complexes, was tested with Plasmodium falciparum malaria hyperimmune serum from patients living in hyperendemic areas and rabbit anti-Proteus spp GDH(NADP+) serum prepared in the laboratory. In this report, we describe the results of a study showing that parasite GDH(NADP+) can be used to detect the presence of Plasmodium falciparum. It appears that this technique permits the chromatographic detection of a Plasmodium falciparum excretion antigen that may be used in the production of monoclonal antibodies to improve immunodiagnostic assays for the detection of antigenemia, and opens the possibility of its use as a non-microscopic screening method.