[Importance of clinical and laboratory profiles for the differential diagnosis of malaria and acute viral hepatitis].

OBJECTIVE To establish clinical and diagnostic findings of malaria and acute viral hepatitis in children, stressing similarities and differences, so as to enhance the sensitivity of early malaria diagnosis in childhood. METHODS Two groups were studied, each including 30 children between 2 and 10 years of age. The patients presented either primary malaria infection or acute viral hepatitis, confirmed by thick blood film and tests for markers of viral hepatitis A and B. The patients were submitted to the following evaluations: erythrocyte, leucocyte and platelet counts, hemoglobin and hematocrit dosage, hepatic enzymes, urea, creatinine and bilirubin dosage. Clinical and laboratory findings were described for both groups and compared. Individuals with alterations on the physical exam in both groups were compared using Fisher's exact test. RESULTS Baseline clinical findings were the same in all patients: fever, headache, digestive problems and dark urine. One half of malaria patients did not present the classical malaria signs, but all of them presented fever, differently from patients with hepatitis. In malaria patients, anemia and thrombocytopenia were significantly more frequent than in hepatitis patients. A remarkable increase of bilirubin and hepatic enzyme levels was found in hepatitis patients. CONCLUSIONS A detailed physical examination and a thorough evaluation of non-specific laboratory tests are sufficient to allow the presumptive diagnosis of both malaria and viral hepatitis, and to reinforce the early diagnosis and treatment of malaria.