Liver Function Assessment in Malaria, Typhoid and Malaria-Typhoid Co-Infection in Aba, Abia State, Nigeria

MATERIALS AND METHODS

One hundred and ten (110) volunteers were randomly selected from inpatients and outpatients(male and female) with febrile illness in Abia State University Teaching Hospital (ABSUTH), Aba , Abia State, Nigeria. All the volunteers were within the age bracket of 22 and 40 years. Blood samples were collected from the patients and were screened for the presence of malaria parasite and Staphylococcus typhi infection who were categorized into 4 groups as follows; Group 1, 30 patients with malaria alone, Group 2, 30 patients with typhoid fever alone, Group 3, 30 patients with malaria-typhoid co-infection, Group 4, 20 patients with no malaria and typhoid fever from the same location with the febrile patients and were considered as a control group. In order to assess the liver function in malaria, typhoid fever and malaria-typhoid co-infection patients, liver function test which measures the presence of various chemicals in the blood made by the liver was carried out. Some of the liver function analysis which include; Blood Bilirubin level (Total and conjugated), Alanine Transaminase (ALT), Aspartate Transaminase (AST) and Alkaline Phosphatase (ALP) were conducted. The study population includes only the febrile patients that have been clinically diagnosed to have malaria, typhoid fever and malaria-typhoid co infection from the result of their malaria parasite and widal tests, respectively.

SAMPLE COLLECTION AND PROCESSING METHOD

Blood samples were aseptically collected from the patients. Two specimen bottles were used for each patient; anticoagulant bottles for malaria parasite test and sterile bottles for widal and liver function assays. Blood samples were collected with undue pressure on either the arm or the plunger of the syringe. The samples in anticoagulant bottles were tested immediately for malaria parasite after staining the film with field stain while those samples in the plain tube were allowed to clot and the clotted samples centrifuged to obtain the sera. The sera were separated into sterile bottles and were stored in the refrigerator at -20^oC until analysis which were of course used for the widal and liver function assays within one week interval.

RESULTS

The results for the analysis of patients with malaria only, typhoid fever only and malaria-typhoid co-infection are shown below in Table 1, 2 and 3, respectively.

The mean values obtained for the various groups were subjected to statistical analysis for difference in means using students t-test and the results showed that there was a significant increase (P<0.05) in the liver function tests (ALP, AST, ALT, TB and CB) carried out on patients with malaria parasite only, when compared to the control.

Table 1:	Variation in the mean values of serum level of different liver function tests carried out on patients with malaria parasite only and the control

Table 2:	Variation in the mean values of serum level of different liver function tests carried out on patients with typhoid fever only and the control

Table 3:	Variation in the mean values of serum level of different liver function tests carried out on patients with malaria-typhoid co-infection and the control

DISCUSSION

Increase of ALT, AST and ALP obtained in this study agrees with the finding of Ignatius et al. (2008) who reported that patients with untreated malaria parasite have high levels of ALP, AST and ALT in their blood. He also stated that this increase in enzyme activities could be attributed to the destruction of the liver parenchyma by the malaria parasite leading to the leakage of the liver enzymes into the general circulation. The result which shows a significant increase (p<0.05) in the level of bilirubin (TB and CB) in patients with malaria parasite only correlates with the work of Kayode et al. (2011) who reported elevated bilirubin (TB and CB) in malaria patients while Etim et al. (2009) reported significantly raised bilirum levels in malaria patients.

Increased serum levels of the various enzymes in the liver function tests carried out on patients with typhoid fever only are indicative of a hepatocyte disorder. The liver function tests are used for evaluation of hepatic involvement during typhoid fever. According to Ali et al. (2007), elevated serum enzymes (ALP, AST and ALT) in his work were discovered in 85% of patients with typhoid fever. Morgenstern and Hayes (1991) and Mirsadraee et al. (2007) in their findings reported that 62 and 70%, respectively of patients with typhoid fever had elevated AST and ALT while Rasoolinejad et al. (2003) reported that 74% of patients with typhoid fever had elevated ALP.

For patients with malaria and typhoid co-infection, the results show a significant increase (p<0.05) in the levels of ALP, AST, ALT, TB and CB. Kayode et al. (2011) reported elevated bilirubin (TB and CB) in malaria and in typhoid co-infection patients which are as a consequence of haemolysis, but in severe cases can lead to the damage of the liver. For the increase in the levels of ALP, AST and ALT, Mbuh et al. (2003) reported that patients with malaria and typhoid co-infection have increased ALP, AST and ALT. Kanjilal et al. (2006) in their work discovered that 87.6% of patient with malaria and typhoid co- infection had elevated ALP, AST and ALT.

CONCLUSION

Malaria, typhoid fever and malaria-typhoid co- infection still remain a major public health problem in many developing countries of the world and when severe and untreated can lead to increase in the serum levels of Alkaline Phosphatase (ALP), Alanine Transaminase (ALT), Aspartate Transaminase (AST) and Bilirubin (Total Bilirubin (TB) and Conjugated Bilirubin (CB).