Early Recognition of Malaria or Dengue Complicated with Thrombocytopenia

Aim of the Study: To observed changes in clinical, haematological and biochemical parameters of dengue and malaria over a period of ten days in patients who presents with low platelet count.

Place and Duration of Study: Lady Harding Medical College, New Delhi, India, November 2013-to March 2015.

Study Design: Prospective observational study.

Sample Size: Total 134 cases of thrombocytopenia with fever were included in the study of which 90 cases were of dengue and 44 were of malaria.

Methodology: Patients of acute fever who were diagnosed as malaria or dengue by peripheral smear, rapid antigen testing or serology were included. Complete blood count including platelet count; liver function test and renal function tests were done in all cases on day 2, 4, 6, 8 and day 10 to see progressive changes. Results were analysed subsequently.

Results: The patients of dengue presented earlier (4.11 ± 1.42) around 4th day as compared to malaria. The skin rash, bleeding tendency, tourniquet test positivity and respiratory abnormalities were more frequent in dengue patients, while abdominal pain, diarrhoea, anaemia, jaundice, hepatomegaly and splenomegaly were more frequent in malaria patients.

White blood cells count showed initial rise in malaria and fall in dengue which gradually recovered by 10th day in both diseases. Fall in haemoglobin was seen only in malaria cases. There was continuous fall in platelet count till 6th day of illness in dengue patient while in malaria patient fall appeared early on 2nd day of fever but was inconsistent, which gradually recovered. Platelet fall was more severe in dengue as compared to malaria, so was bleeding tendencies. Bleeding tendencies were more frequent when the platelet count was below 20,000/µL.

Transaminase levels were more severely deranged and manifested early in malaria, while serum creatinine and blood urea were more deranged in dengue. Both these biochemical abnormalities return to normal by 10th day of illness.

Conclusion: There are certain differences between clinical, haematological and biochemical parameters in malaria and dengue for early diagnosis. We suggest that our observations can be used in remote areas where facilities for specific test are not available or limited by financial constrains or in epidemics.