Liver Involvement in Falciparum

Malaria –is treated with putapakwa vishama jwaranthaka loha

–a pilot study.

Dr.R

ajim

unni

sa b

egum

P,G

sch

olar

Dep

t.of k

.c,

Dr.B

.R.K

.R g

ovt.a

yurv

edic

col

lege

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INTRODUCTION

Epidemiology

Prevalence(Gender& age)

International ranking

MORBIDITY &MORTALITY

International distribution

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What is Plasmodium Falciparum?

•Protozoa•Malaria

http://www.traveldoctor.info/diseases/1.html

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IMPACT

•300 million acute illness

•100 million deaths

•A child in Africa dies every 30 seconds

http://mosquito.who.int/cmc_upload/0/000/015/372/RBMInfosheet_1.htm

Most vulnerable population

http://www.lakareutangranser.se/default.asp?mall=1&ArtikelID=165&UrvKat=43&Kategori=

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Life cycle of Plasmodium Falciparum

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HISTO PATHOLOGICAL CHANGES IN LIVER

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Changes in kupffer cells

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sinusoidal dilatation with lymphocytic cells

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swollen hepatocytes with foamy clear cytoplasm

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periportal hypercellularity

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RE cell laden with malarial pigment

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CLINICAL STUDY

OBJECIVES

DURATIONSIZE OF SAMPLE

PARAMETERS

SUBJECTIVE• Aniyatha Jwara• Vepana• Chardhi• Shira Shoola• Aruchi• Parshwa soola• Tandra• Yakrith vrudhi• Pleeha rudhi Anidra,Tandra

OBJECTIVE• Thick &Thin blood film

for malaria• Peripheral smear test

for MP• ESR• Hb%• Temp chart

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CRITERIA FOR SELECTION

Exclusive•Pt. below 15 yrs & above 60yrs•Pt .with complications like anemia,•R.F•P.E•Jaundice•Spleen rupture•C.M•Pregnant women

Inclusive

•Age of the pt.B/w15-60 yrs•Uncomplicated malarial fever•Peripheral smear test for M.P must be positive

Diagnostic

•The symptoms of vishama jwara mentioned in ayurvedic text will be the basic diagnostic criteria•Peripheral smear for MP

DIAGNOSTIC POINTS FOR P.FALCIPARUM

• Red cells are not enlarged.• Rings appear fine & delicate & there may be

several in one cell.• Presence of marginal or appliqué forms.• It is unusual to see developing forms in

peripheral blood films.• MAURER’S dots may be present.• However they don't usually appear in the blood

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DRUG REVIEW

• PUTAPAKWA VISHAMA JWARANTAKA LOHA• Parada-------20gms• Gandaka----20gms• Swarna------5gms• Louha---------40gms• Tamra--------40gms• Abraka-------40gms• Vanga--------10gms• S.gairika----10gms• Pravala,Mukta,sanka& sukti------5gmsApr 15, 2023 K.C P.G 17

Dose-250 mg (bid) AnupanaHoney,pippali,chu.Hing.chu.

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INDICATIONS & MODE OF ACTION OF THE DRUG

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RESULTS

• GRADING ABSENT -0 MILD -1 MODERATE -2 SEVERE -3

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Statistical analysis of resultsSUBJECTIVE B.T A.T

Aniyamita jwara 6 4

Vepana 4 2

A Chardhi 6 4

Shira shoola 6 2

Parshwa soola 4 1

Tandra 1 0

Swasa 4 2

Yakrith vridhi 6 2

Pleeha vridhi 4 2

Anidra 4 1

Aruchi 2 0

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Cont………..OBJECTIVE B.F A.F

M.P smear (positive) 26 7

Hb% 9.195 9.51

ESR 15 11

Total count 6239 6080

Neutrofits 54 60

Lymphocytes 38 31

Esinophils 5 4

Monocytes 1 +1

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Results No. Of patients % of relief

Good /Complete relief

2 75%

Moderate relief 0 0

Poor/no relief 0 0

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LATEST RESEARCH WORKS

Apr 15, 2023

DISCUSSION• Liver involvement in malaria is common in patients of severe malaria and may

manifest as jaundice – i.e., raised serum bilirubin, hepatomegaly, elevated liver enzymes like aspartate and alanine transaminases. There may be a low and falling serum albumin, and prothrombin time may be Prolonged.

• Severe Falciparum malaria may present as coma, jaundice, and renal failure and the severe disease must not be mistaken for fulminate hepatic failure as there is a better to therapy in cases of malaria.

• cases of severe jaundice and encephalopathy due to Falciparum malarial hepatitis initially diagnosed as fulminate hepatic failure were reported, the liver function

• showed predominantly conjugated hyperbilirubinaemia with modest elevation of aspirate, alanine transaminases,and alkaline phosphatase level, and it was concluded “that

• liver biopsy is a valuable tool in establishing the diagnosis at all the stages of disease.

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CONCLUSION

• Liver involvement in malaria is common in patients of severe malaria and may manifest as jaundice .

• P.V.LOHA found effective in P.falciparum & p.vivax.

• Severe Falciparum malaria may present as coma, jaundice, and renal failure and the severe disease must not be mistaken for fulminate hepatic failure as there is a better response to therapy in cases of malaria.

• P.V.LOHA is effective in chronic cases & very effective in freshly reported cases.

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REFERENCES

• park's text book of preventive & social medicine.

• M.Ni .2 /26,36.• Su.U.36/56.• C.Chi.3/74.• B.R. 5/1161 .1169.• A.H. NI.3/69.• B.P V.PRAKARANA 722 sloka.• Y.R V.P 1 sloka.

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THANK U