The Dynamics of Liver Function Test Abnormalities after Malaria Infection: A Retrospective Observational Study

Abstract

Abstract.Liver dysfunction has long been recognized as a clinical feature of malaria. We have observed delayed elevation in the transaminase portion of liver function tests (LFTs) after treatment in some participants undergoing induced blood stage malaria infection. We sought to determine whether similar LFT elevations occur after naturally acquired infection. We performed a retrospective audit of confirmed cases of Plasmodium falciparum and Plasmodium vivax in Queensland, Australia, from 2006 to 2016. All LFT results from malaria diagnosis until 28 days after diagnosis were collected with demographic and clinical information to describe longitudinal changes. The timing of peak LFT elevations was classified as early (0–3 days), delayed (4–11 days), or late (12–28 days) with respect to the day of diagnosis. Among 861 cases with LFT evaluated, an elevated bilirubin level was identified in 12.4% (N = 107/861), whereas elevated alanine transaminase (ALT) and aspartate transaminase levels were observed in 15.1% (N = 130/861) and 14.8% (N = 127/861) of cases, respectively. All peak bilirubin results occurred in the early period, whereas ALT elevations were biphasic, with elevations in the early and delayed periods, with 35.4% (N = 46/130) of cases delayed. Univariate and paired stepwise logistic regression analyses were performed to investigate factors associated with the incidence and timing of transaminase elevation. A raised ALT level at diagnosis was strongly associated with the timing of transaminase elevation. No other demographic, parasitic, or treatment factors were associated. Liver function test abnormalities are likely an inherent although variable aspect of human malaria, and individual-specific factors may confer susceptibility to hepatocyte injury.

Spread of multidrug-resistant Plasmodium falciparum malaria and predictors of treatment failures in Vietnam

“…Our findings are in line with the other reports (18,30). Mild elevations of transaminases are common in Plamodium infection, particularly in P. falciparum infection because of hemolysis that affects the liver function (33). About 30% of patients in our study had transaminase higher than 40 U/L.…”

Malaria-attributable fraction of fever episodes among HIV-seropositive patients in the Western highland area of Cameroon

“…This study evaluates the malaria-attributable fraction of fever episodes among HIV seropositive patients in Dschang, a town in the highland area of the Bamiléké plateau in western region of Cameroon, with hypoendemic peculiarities as far as malaria epidemiology is concerned [32,65]. The protocol design was tested and approved in the framework of a concomitant study, aiming at evaluating the feasibility and effectiveness of a triple ARV therapy for prevention of mother-to-child transmission at the DREAM centre [66].…”

“…Axillaries' temperatures and the other symptoms were recorded on this first day of consultation, to enable separation of patients into 2 groups: febrile (and/or symptomatic) and non-febrile, based on the definition of malaria related symptoms in this locality [32]. Weights (w) of patients were recorded using a personal weighing machine, while the height (h) was measured with a height gauge.…”

“…Clinical examination data of all the 729 seropositive patients were recordered and 119 (16.3%) were febrile and/or carried malaria-like symptoms [32]. Among this group of feverish people, only one person was infected with Plasmodium after parasitological examination ( Table 3)…”

“…It appears mostly in case of severe malaria and is more likely to occur in presence of other complications [31]; hence coinfection with HIV could favour its development. Moreover, individualspecific factors may confer more or less susceptibility to hepatocyte injury [32]. The importance of proving whether or not Plasmodium infection induces greater hepatocellular disease in immunodeficient people is of great consequence, because if such were the case, these patients should be treated for hepatitis as well as malaria.…”