METHEMOGLOBINEMIAAND RAISED SERUM THIOBARBITURIC ACID REACTIVE SUBSTANCE LEVELS IN MALARIA

Background:Methemoglobinemia is found in patients with vivax and falciparum malaria. We study the relation between Methemoglobinemia and lipid peroxidation which is a marker of reactive oxygen species and its role as a biomarker in prognosis of patients with falciparum malaria.

Material and Methods: 133 patients of falciparum malaria and 25 control subjects were enrolled for the study. Blood was collected for estimation of Methemoglobin, thiobarbituric acid reactive substances (TBARS) calorimetrically. TABRS reflected amount of lipid peroxidation that indirectly measures reactive oxygen substances(ROS). The correlation between Methemoglobinemia, TBARS, parasites, and outcome of falciparum malaria was analyzed.

Results:The present study enrolled 133 patients of falciparum malaria of which 48 were with uncomplicated (UM) and 85 patients with severe falciparum malaria (SM) and 25 normal persons as controls. All were followed up to 7 days. Out of 85 patients 2, 3, 4, and 5 organ dysfunctions constituted 19 (22.3%), 38 (44.5%), 19 (22.1%), and 9 (12.0%) patients, respectively. The concentration of Met-Hb in UM was 4.1 ±1.2 % (p<0.001) and increased with SM to 11.1 ±7.2 % (Table-1). After 7 days of treatment it tends to return to normal (p<0.001). The level of TABRS was high in UM compared to controls and higher in SM than SM(p<0.001). There is a significant correlation between Met-Hb and TABRS and with parasitemia. A positive correlation exists between parasite count and Met-Hb level (r = 0.930, p < 0.0001), between parasite count and serum TBARS level (r = 0.948, p < 0.0001) and between Met-Hb and serum TBARS level (r = 0.917, p < 0.0001). In total 15 cases (17.6%) died during the study and the patients who died had a high Met-Hb (14.5 ±3.6%) compared to survivors 11.4 ±4.6% (p<0.001) and high TABRS (6.5 ±2.6 nmol/ml) compared to the survivors 5.9 ±3.6 nmol/ml (p<0.001).

Conclusion:In the present study we found Methemoglobinemia is high among patients with UM and SM. Met-Hb also high among the patients who died. Methemoglobinemia is directly correlated to parasitic count, TABRS, and mortality. It can be used as a prognostic marker of SM.