EFFECTS OF SEVERITY OF PLASMODIUM FALCIPARUM INFECTION ON SERUM LIVER ENZYMES OF NIGERIAN CHILDREN

Abstract

Liver involvement in malaria infection is now a known entity with its specific histopathological changes. Cases with altered liver function tests, fulminant hepatic failure and hepatic encephalopathy have been reported. Many studies have been done on serum hepatic biochemical parameters and malaria especially in adults within and outside Nigeria. Fewer of these studies have been done in Nigerian children. The limitation of most of these studies was their failure to correlate the changes in serum level of hepatic biochemical parameters with the degree of falciparum parasitaemia. OBJECTIVES: To determine the effects of degree of Plasmodium falciparum parasitaemia on serum liver enzymes in Nigerian children. This is with a view to correlate the degree of parasitaemia of Plasmodium falciparum with severity of hepatic injury. MATERIALS AND METHOD:
A total of 400 paediatric patients (with ages ranging between 1 and 12 years) were consecutively recruited for the study. The patients were grouped into three based on the degree of parasitaemia as mild, moderate and severe by blood film microscopy. There were 200 controls recruited for the study. They matched the study population in age and gender and were divided into two groups. The first 100 were febrile non-parasitaemic patients with mean age of 4.7±3.4 years. The second group of 100 were afebrile non-parasitaemic patients with mean age of 4.7±3.0 years. The controls were recruited from the Paediatric Surgical Unit and Family Medicine Department. The serum samples of the parasitaemic patients and that of the non-
parasitaemic controls were analyzed for alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma glutamyl transferase (GGT) and bilirubin.

RESULTS: The mean age of the parasitaemic patients was 5.3±3.1 years. Two hundred and four (51.0%) were males while 196(49.0%) were females. Male:Female ratio of 1.04:1 Of the 400 patients recruited for the study, 155(38.8%) were recruited at the Emergency Paediatric Unit while the remaining 245(61.2%) were recruited at the Department of Family Medicine Clinics of the University of Ilorin Teaching Hospital, Ilorin. The mean age of the patients with severe parasitaemia was 3.8±2.4 years (less than five years); those with moderate parasitaemia was 6.8±3.9 years (around seven years) while those with mild parasitaemia was 5.2±3.1 years (less than seven years). The study also showed that there were statistically significant differences in the mean serum levels of AST, ALT, ALP, GGT, total bilirubin, conjugated bilirubin and unconjugated bilirubin in the malarial parasite positive groups when compared with febrile malarial parasite negative controls and afebrile malarial parasite negative controls. Except for serum GGT whose level decreases with severity of falciparum parasitaemia, serum levels of AST, ALT, ALP, GGT, total bilirubin, conjugated bilirubin and unconjugated bilirubin increase with degree of parasitaemia. Predominant type of hyperbilirubinaemia was also found to be unconjugated hyperbilirubinaemia. The AST/ALT ratio decreased with the severity of falciparum parasitaemia in the parasitaemic groups. It was 0.83±0.68 in febrile
malaria parasite negative controls and 1.0±2.3 in afebrile malaria parasite negative controls. The AST/ALT ratio was found to be lower in the three parasitized groups than the controls. The mean values of serum AST, ALT, ALP, GGT and AST/ALT ratios in the combined Parasitaemic Group were significantly higher statistically than those of the combined controls at p-values of <0.001 except for AST/ALT ratios that was 0.05. The values of total bilirubin and conjugated bilirubin in the combined parasitaemic group were significantly higher statistically than those of the combined controls at p-values of <0.001 except for serum unconjugated bilirubin that was lower in the combined parasitaemic group than that of the combined controls at p-value of <0.001. CONCLUSION: There was a positive correlation between serum levels of hepatic enzymes (ALT, AST and ALP) and bilirubin levels with severity of falciparum parasitaemia. Degree of parasitaemia had negative correlation with GGT level.

EFFECTS OF SEVERITY OF PLASMODIUM FALCIPARUM INFECTION ON SERUM LIVER ENZYMES OF NIGERIAN CHILDREN