Temporal trends, clinical manifestations, and patient outcomes of falciparum malaria infection at wad-medani teaching hospital in the central region of Sudan

Background: Malaria is one of the most common diseases affecting humans worldwide. It remains a major global public health concern and a major cause of morbidity and mortality in tropical and subtropical countries. Plasmodium falciparum malaria is the most dangerous and fatal form of the illness, and it is the most common species prevalent in Sudan throughout the year. Gastrointestinal manifestations are common in malaria-endemic areas. Malaria occasionally presents with both typical and atypical symptoms and signs, and there is an increased burden on health services in hospitals due to the large spectrum of falciparum malaria presentation and outcome, especially in the Gezira area in Sudan. Objectives: To assess the trend, manifestations, and outcome of falciparum malaria infection in patients admitted to medical wards. Methods: This is a descriptive, prospective, cross-sectional hospital-based study, conducted in Wad Medani Teaching Hospital in the central region of Sudan during the period from December 2014 to May 2015. Results: A total of 160 patients were admitted with severe malaria during the period from December 2014 to May 2015. The age of the study population ranged from 15-80 years, with a mean age of 43.11 years, with the most affected patients in the age group 15-45 years. Males were 86 (53.8%) and females 74 (46.3%). The main manifestations and complications of severe falciparum malaria in this study were: hyperparasitemia, which was present in 90 patients (56.3%), followed by hypotension or circulatory collapse, which was observed in 52 patients (32.5%), hyperpyrexia was seen in 35 patients (21.9%), prostration and weakness seen in 33 patients (20.6%), cerebral malaria with loss of consciousness seen in 19 patients (11.9%), acute kidney injury (AKI) was seen in 18 patients (11.3%), hypoglycemia was seen in 18 patients (11.3%), repeated convulsions ≥ 3 frequency occurred in 14 patients (8.8%), severe anemia was seen in 10 patients (6.3%), abnormal bleeding occurred in 10 patients (6.3%), and hyperbilirubinemia also in 10 patients (6.3%). Pulmonary edema was found in 2 cases (1.3%), and disseminated intravascular coagulation (DIC) in 2 cases (1.3%), blackwater fever in one case (0.6%). Other complications like acute respiratory distress syndrome (ARDS) and acidosis were not reported in this study. Patients who received quinine hydrochloride salt via intravenous infusion were 153 (95.6%), and those who received artemether injection were 7 (4.4%). Some patients received supportive management according to their presentation. The main duration of hospital stay was 3-5 days in 87 patients (54.4%). The outcome was as follows: 154 patients (96.3%) improved and were discharged in good condition, and six patients (3.8%) died. Conclusion: Falciparum malaria is more common among younger adult age groups and males. The main manifestations and complications of severe falciparum malaria infection were hyperparasitemia, hypotension, hyperpyrexia, prostration and weakness, cerebral malaria, AKI, then hypoglycemia and repeated convulsions, and severe anemia. Most of the patients were treated with quinine with very good response, and the mortality rate was 3.8%.