Bannu Medical College, & Khalifa Gulnawaz Teaching Hospital, - PDF document

Unusual Presentation of Falciparum Malaria as generalized Anxiety Disorder at DHQTH Bannu Abdul Majid et al Original Article Unusual Presentation of Abdul Majid* Mohammad Shoaib Khan** Falciparum Malaria as generalized Ch. Mohammad Fiaz*** Anxiety Disorder at DHQTH Department of Medicine, Bannu Bannu Medical College, & Khalifa Gulnawaz Teaching Hospital, Bannu, NWFP *Department of Biochemistry, Background: Falciparum Malaria is the most serious and dangerous type of malaria. Patients with Bannu Medical College & Falciparum Malaria may not be apparently seriously ill but may develop serious complications. Khalifa Gulnawaz Teaching Falciparum Malaria differs from all other types of malaria, in its severity and diverse clinical Hospital, Bannu, NWFP. presentation. ***Department of Pathology, Objective: This study was carried out to present the unusual presentation of Falciparum Malaria in Pakistan Institute of Medical the form of generalized anxiety disorder. Sciences, Islamabad Place and duration of study: This study was carried out in the medical OPD of DHQTH Bannu NWFP from March 2005 to March 2007. Sampling Technique : Convenient sampling. Inclusive Criteria: All patients presenting with symptoms and signs of generalized anxiety disorder and found positive for Plasmodium falciparum (P.F.) were included in the study. Exclusion Criteria: 1. Those patients found positive for P.F. but presenting with other symptoms of P.F. malaria. 2. Those patients already suffering from anxiety disorder or other psychiatric illness. Limitations of the study: Only the patients attending the Medical OPD of DHQTH of Bannu, during the years from 2005 to 2007 were included. Material and Methods: A total of 2300 patients of both sexes and above the age of 15 years were included in the study. Only those patients with symptoms of generalized anxiety disorder and found positive for the asexual forms of P.F. in the peripheral blood were included in the study. A detailed Performa was completed from all patients. Results: Out of 2300 patients, 253(11%) were found positive for P.F. Out of 253 patients, 39(15.5%) were males and 214(84.5%) were females. Seven (3.2%) females were pregnant. The Address for Correspondence common presentations of patients were headache, palpitation, insomnia and epigastric pain. Dr, Mohammad Shoaib Khan Conclusion: This study reveals that Plasmodium falciparum can present with rare clinical features Associate Professor &Khalifa which need to be further evaluated. Due attention should be given to all the patients while Gulnawaz Teaching Hospital recording their clinical history and all patients with vague symptoms should not be just labeled as Bannu Medical College, Bannu neurotic or hysterical. Key Words : Plasmodium falciparum, Anxiety Disorder . programme, malaria affects 300-500 million people Introduction each year and up to 3 million deaths per year globally 4 . In Pakistan, malaria affects the low socioeconomic Malaria is one of the most important groups which constitute about 40% of the total communicable parasitic disease which is caused by bite population, especially in the southern and northern of infected female Anopheles mosquito, though it can districts of NWFP Plasmodium falciparum is the most also be acquired by use of contaminated syringes, serious type of all four types of malaria because of its through blood transfusion or transplacental route 1,2,3 .It fatal complications 5 .That is why delay in the treatment is a major public health problem throughout the world of Falciparum malaria may lead to serious and fatal especially developing countries including Pakistan. consequences 6 . The Roll Back Malaria (RBM) programme was started in Pakistan in 1998. According to this Ann. Pak. Inst. Med. Sci. 2011; 7(1): 26-28 26

Unusual Presentation of Falciparum Malaria as generalized Anxiety Disorder at DHQTH Bannu Abdul Majid et al At present, the prevalence of Falciparum Malaria is on rise and accounts for almost 18-62% of all Table I: Age and Sex wise distribution of cases of malaria in various regions of Pakistan with 253 P.F. positive patients resistance to one or more anti malarial drugs 7, 8 . The Age (years) Males Females Total increasing prevalence of malaria in Pakistan may be 15-25 8(3.1%) 55(21.7%) 63(24.9%) due to the influx of Afghan refugees especially in NWFP 26-35 10(3.9%) 68(26.8%) 78(30.8%) and Balochistan, uncontrolled urbanization, 36-45 14(5.5%) 75(29.6%) 89(35.1%) uncontrolled population growth rate and environmental changes due to draughts, heavy rains, earth quakes, 46-55 7(2.7%) 16(6.3%) 23(9.0%) floods, and water development projects 9 . Plasmodium Total 39(15.5%) 214(84.5%) 253(100%) falciparum malaria is unique among other types of malaria because of its severity and diversity in clinical Table II: Symptoms/ Sex wise distribution presentation 10, 11, 12 . of 253 P.F. positive patients The aim of out study was to present the unusual presentation of Falciparum Malaria in the form Symptoms Males Females Total of generalized Anxiety Disorder. Headache 10(25.6%) 62(28.9%) 72(28.4%) Palpitation 8(20.5%) 54(25.2%) 62(24.5%) Material and Methods Insomnia 8(20.5%) 47(21.9%) 55(21.5%) Epigastric Pain 7(17.9%) 22(10.2%) 29(11.4%) This study was conducted in the outpatient Nausea 2(5.1%) 10(4.6%) 12(4.7%) department (OPD) of DHQ teaching hospital Bannu Irritability 2(5.1%) 8(3.7%) 10(3.9%) from March 2005 to March 2007. A total of 2300 Difficulty 1(2.5%) 8(3.7%) 9(3.5%) patients of both sexes and above the age of 15 years Concentrating were included in the study. All the patients were Near Syncope 1(2.5%) 3(1.47%) 4(1.5%) screened for Plasmodium falciparum malaria by thin and thick smears. The inclusion criteria was only those Total 39(15.5%) 214(84.5%) 253(100%) patients who presented with symptoms of generalized Discussion Anxiety Disorder and were found positive for asexual forms of Plasmodium falciparum. Those patients who Detail review of the literature shows that were found positive for Plasmodium falciparum but who Plasmodium falciparum malaria can present with wide presented with other symptoms of Plasmodium variety of clinical features. It can present with Jaundice, falciparum malaria or those who were already suffering hepatitis, permanent hepatic failure and even hepatic from anxiety or other psychiatric problems were coma 13-16 , symptoms and signs suggestive of excluded from the study. A detailed performa consisting gastrointestinal involvement in the form vomiting, of name, age, sex, address, occupation, detailed diarrhea, abdominal pain, acute gastro enteritis, acute clinical history, examination and relevant investigations pancreatitis 11,14 . CNS involvement can occur in the form was prepared and completed from each patient. of cerebral malaria, headache, altered conscious level, seizures and signs of meningism 11,17,18 . Results Plasmodium falciparum malaria may present in the form of sever anemia, leukemoid reaction, bleeding Out of 2300 patients, who presented with tendency, epistaxis and even disseminated intravascular symptoms of generalized anxiety disorder, 500(21.7%) coagulation. 10, 12, 14, 16 It can present with hamaturia, were males and 1800(78.3%) were females. Out of the black water fever, uremia and acute renal failure. 10,11,16 total patients screened, 253(11%) were found positive for Plasmodium falciparum. Out of these 253 patients, Respiratory system may be affected by P.F. malaria in the form of pulmonary edema and Adult respiratory 39(15.5%) were males and 214(84.5%) were females. distress syndrome (ARDS), 14, 17 . P.F can present as Seven (3.2%) patients were pregnant. Age range of the placental malaria 3 in which the peripheral blood smear patients was 15-55 years with peak incidence of is negative for Plasmodium falciparum but placental Plasmodium falciparum in the age range of 36-45 biopsy specimen on histology shows Plasmodium years. The most important presenting symptoms of falciparum. After thorough study of the national and the patients in our study were headache (28.4%), international literature on clinical presentation of P.F palpitation (24.5%) and insomnia (21.7%) especially in malaria, I was unable to find the clinical features which female patients (84.5%). The age/sex wise distribution the patients in our study were presenting with. This of patients is shown in table I where as the symptoms study on unusual presentation of P.F malaria was and sex wise distribution is shown in table II. Ann. Pak. Inst. Med. Sci. 2011; 7(1): 26-28 27