BackgroundErythrocyte-associated antigenic polymorphisms or their absence have perhaps evolved in the human population to protect against malarial infection. Studies in various populations consistently demonstrate that blood group 'O' confers resistance against severe falciparum infection. In India, Odisha state has one of the highest incidences of Plasmodium falciparum infection and contributes to the highest number of deaths by falciparum malaria. This study aims to evaluate the relationship between ABO blood group and severe malaria in an adult population at the tertiary care centre in Odisha.MethodsA total of 353 P. falciparum infected subjects and 174 healthy controls were screened for ABO blood group. Falciparum-infected individuals were categorized as severe malaria and uncomplicated malaria. Severe malaria was further clinically phenotyped into cerebral malaria, non-cerebral severe malaria and multi-organ dysfunction. A meta-analysis was performed to assess the role of ABO blood group in severe malaria.ResultsFrequency of blood group 'B' was significantly higher in patients with severe malaria compared to the uncomplicated cases (P < 0.0001; OR = 4.09) and healthy controls (P < 0.0001; OR = 2.79). Irrespective of the level of clinical severity, blood group 'B' was significantly associated with cerebral malaria (P < 0.0001; OR = 5.95), multi-organ dysfunction (P < 0.0001; OR = 4.81) and non-cerebral severe malaria patients (P = 0.001; OR = 3.02) compared to the uncomplicated category. Prevalence of 'O' group in uncomplicated malaria (P < 0.0001; OR = 2.81) and healthy controls (P = 0.0003; OR = 2.16) was significantly high compared to severe malaria. Meta-analysis of previous studies, including the current one, highlighted the protective nature of blood group 'O' to severe malaria (P = 0.01). On the other hand, carriers of blood group 'A' (P = 0.04) and 'AB' (P = 0.04) were susceptible to malaria severity.ConclusionsResults of the current study indicate that blood group 'O' is associated with reduced and 'B' blood group with increased risk of development of severe malaria in Odisha, India. Meta-analysis also supports the protective nature of blood group 'O' from severe falciparum infection.

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Background: Dengue infection is a major public health threat; early recognition is crucial to improve the survival in severe dengue. For prediction of dengue, various biomarkers are present but they are rarely used. We used serum ferritin to predict the severity at an earlier stage. Methods: This is a prospective observational study conducted in a tertiary health care centre involving 200 dengue cases diagnosed by positive NS1 antigen by ELISA. Serum ferritin was measured in all at the time of diagnosis, day 3 and day 7. We monitored the patients both clinically and biochemically daily and classified them as severe and non-severe according to 2009 WHO criteria. Results: The mean age of the patients was 34.14±12.4 years. Out of 200 patients, 136 (68.0%) patients were male and rest 64 (32.0%) were females, 56 developed severe dengue. All the 200 patients had fever (100%) and arthralgia (100%). Other clinical symptoms like rash, nausea, abdominal pain, persistent vomiting, mucosal bleeding, liver enlargement, clinical fluid accumulation, dengue haemorrhagic fever, dengue shock syndrome, altered sensorium, severe plasma leakage, and patients with ALT more than 1000 U/L was reported in 108 (54.0%), 58 (29.0%), 46 (23.0%), 59 (29.5%), 32 (16.0%), 19 (9.5%), 13 (6.5%), 9 (4.5%), 35 (17.5%), 2 (1%), 12 (6.0%) and 3 (1.5%) patients respectively. The serum ferritin level was correlated with patients having rash, abdominal pain and persisting vomiting both on day 3 and day 7. A negative correlation was observed between serum ferritin level and total platelets count both on day 3 (r=-0.2226; p=0.0016) and day 7 (r=-0.3562; p=0.0001). Patients with severe dengue had significantly low platelet count and higher ferritin levels. Conclusions: Elevated serum ferritin levels can be used as a potential early prognostic marker to predict the severity of dengue infection in clinical practice.

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