Cerebral malaria or Plasmodium falciparum malaria with hypoglycaemia (original) (raw)
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Nigerian journal of paediatrics, 2022
Background: Many clinicaland haemato lo g ical changes occur as a result of severe malaria, of which cerebral malaria (CM) is a common entity. These changes affect virtually all organs and systems of the body. We identify various clinical and haematological determinants of outcome in CM so as to institute proactive management of such children. Methods: All children who met World Health Organization (WHO) diagnostic criteria for CM over 8 month-period were prospectively studied. The presenting symptoms and its duration, detailed physical examination and laboratory parameters were obtained. Logistic regression was employed to determine the prognostic significance of various clinical and laboratory parameters. Outcome indicators were full recovery, alive with neurological sequelae or death of the children. Results: Of the 892 children admitted into the Children Emergency Unit (CEU) over the study period, 50 (5.6%) had CM with M: F ratio of 1:1 and age range of 6 months to 12 years. Sixty percent were aged less than 5 years. The defining symptoms were fever (100%), coma (100%) and convulsion (98%). Forty-one (82%) patients survived , while nine (18%) died. Of the 41 survivors, 30 (73.2%) recovered fully, while 11 (26.8%) had neurological deficits at discharge. Identified clinical and laboratory predictors of mortality and neurological sequelae in CM included Blantyre coma score of 0-2(p = 0.018) prolonged coma recovery time > 26 hours (p = 0.026), abnormal breathing pattern (p = 0.0124), absent corneal reflex (p = 0.012), absent pupillary reflex (p = 0.012), depressed tendon reflex (p = 0.028), hyperreflexia (p = 0.014), retinal haemorrhage (p = 0.001), duration of admission (p= 0.000), hyper parasitaemia (p = 0.001), hypoglycemia (p= 0.014) and leucocytosis (p = 0.008). Independent determinants of immediate post-recovery neurological deficits and death were hyper-parasitaemia (OR = 8.657, p = 0.017.) and leucocytosis(OR = 1.090; p = 0.035 Conclusion: CM is a potentially reversible encephalopathy associated with high mortality and sequelae. Affected children with the above listed clinical / haematological parameters especially hyperparasitemia and leucocytosis should be given proactive management to improve the outcome.
Biochemical and haematological variables in Gambian children with cerebral malaria
Annals of Tropical Paediatrics: International Child Health, 1999
Biochemical and haematological measurements were made in Gambian children who satis® ed the criteria for the diagnosis of cerebral malaria over a 3-year period. Biochemical and haematological values were available for 388 and 624 children, respectively. Biochemical signs of renal and hepatic dysfunction were found and these may have contributed in a cumulative way to the high mortality seen in the study children. Cerebral involvement in children with cerebral malaria is only one, though the most important, manifestation of a multi-organ disease.
International Journal of Epidemiology, 1997
Usual estimates of case fatality rate (CFR) in paediatric cerebral malaria range between 6 and 50%. 1 Since the studies did not use the same case definition, useful comparisons cannot be made. A fatality rate of 50% may occur among children living in rural areas with limited access to specialist treatment, 2 but is certainly an overestimation for children attending hospitals with reasonable resources. In such settings, all the studies report a CFR of less than 30%. In a drug trial in Ghana including 113 cases of cerebral malaria, the CFR was as low as 5%, and the occurrence of neurological sequelae was 8%. 3 In the four largest studies in Africa, mainly observational, including more than 100 children with cerebral malaria, the CFR were 15% in Malawi 4 and Congo, 5 16% in The Gambia 6 and 17% among the cerebral malaria group in Kenya. 7 The respective prevalence of residual neurological sequelae were 9% in Malawi and Congo and 8% in The Gambia. Thus, when investigators use
Cerebral malaria: a lethal complication of a common tropical infection
International Journal of Research in Medical Sciences, 2021
Cerebral malaria (CM) represents a deadly neurological complication associated with Plasmodium falciparum infection. It is defined as an unarousable coma or a deep level of unconsciousness in the presence of a P. falciparum parasitemia, the diagnosis confirmed after exclusion of other common causes of coma such as hypoglycemia, septicemia, metabolic derangements and bacterial and viral meningitis/encephalopathies. Mortality is high and some surviving patients sustain neuronal injury which manifests as long-term neuro-cognitive impairments. Microscopy of Giemsa-stained blood smears remains the gold standard for confirmation of malaria diagnosis. The purpose of this review was to summarize the updated knowledge on the disease, its presentation, complications and neurological sequelae and the presently available newer and experimental adjuvant therapies. For this review, a PubMed search was conducted for articles and case reports from 1968 to 2020 containing the keywords cerebral malar...
A Literature Review of Clinical Characteristics of Cerebral Malaria
International journal of scientific advances, 2023
Malaria is a disease transmitted by the bite of the female Anopheles mosquito and caused by protozoa of the genus Plasmodium. Malaria infection has several manifestations with cerebral malaria (CM) being the most severe neurological complication and a leading cause of malaria death. Cerebral malaria is characterized by a coma at least 1 hour after a seizure or a hypoglycemia, asexual forms of Plasmodium falciparum on peripheral blood smears, with the absence of any other causes of coma. This definition is quite vague in practice, thus making an accurate identification of clinical characteristics of cerebral malaria necessary in diagnosis to help reducing malaria deaths. This article is to summarize the medical literature to clarify the clinical characteristics of cerebral malaria.
Neurological Involvement in Falciparum Malaria in African Children
Neuropediatrics, 2006
ALARIA IS A LEADING cause of ill health in tropical countries. In 2002, more than 2 billion individuals were exposed to malaria and an estimated 515 million clinical episodes of acute Plasmodium falciparum infection occurred. More than 70% of these episodes occurred in sub-Saharan Africa and mainly affected children younger than 5 years. 1 Plasmodium falciparum is the most common cause of severe malaria and in children this typically manifests as severe anemia, prostration, repeated seizures, impaired consciousness, hypoglycemia, and metabolic acidosis. 2 Uniquely, P falciparum-infected erythrocytes sequester within deep vascular beds, particularly in the brain. 3 Neurological involvement may manifest as seizures, impaired consciousness, or coma. 4 Recent studies demonstrate that nearly a quarter of children who survive cerebral malaria or malaria with complicated seizures are at risk for per-Context Plasmodium falciparum appears to have a particular propensity to involve the brain but the burden, risk factors, and full extent of neurological involvement have not been systematically described. Objectives To determine the incidence and describe the clinical phenotypes and outcomes of neurological involvement in African children with acute falciparum malaria. Design, Setting, and Patients A review of records of all children younger than 14 years admitted to a Kenyan district hospital with malaria from January 1992 through December 2004. Neurological involvement was defined as convulsive seizures, agitation, prostration, or impaired consciousness or coma. Main Outcome Measures The incidence, pattern, and outcome of neurological involvement. Results Of 58 239 children admitted, 19 560 (33.6%) had malaria as the primary clinical diagnosis. Neurological involvement was observed in 9313 children (47.6%) and manifested as seizures (6563/17 517 [37.5%]), agitation (316/11 193 [2.8%]), prostration (3223/15 643 [20.6%]), and impaired consciousness or coma (2129/ 16 080 [13.2%]). In children younger than 5 years, the mean annual incidence of admissions with malaria was 2694 per 100 000 persons and the incidence of malaria with neurological involvement was 1156 per 100 000 persons. However, readmissions may have led to a 10% overestimate in incidence. Children with neurological involvement were older (median, 26 [interquartile range {IQR}, 15-41] vs 21 [IQR, 10-40] months; PϽ.001), had a shorter duration of illness (median, 2 [IQR, 1-3] vs 3 [IQR, 2-3] days; PϽ.001), and a higher geometric mean parasite density (42.0 [95% confidence interval {CI}, 40.0-44.1] vs 30.4 [95% CI, 29.0-31.8] ϫ10 3 /µL; PϽ.001). Factors independently associated with neurological involvement included past history of seizures (adjusted odds ratio [AOR], 3.50; 95% CI, 2.78-4.42), fever lasting 2 days or less (AOR, 2.02; 95% CI, 1.64-2.49), delayed capillary refill time (AOR, 3.66; 95% CI, 2.40-5.56), metabolic acidosis (AOR, 1.55; 95% CI, 1.29-1.87), and hypoglycemia (AOR, 2.11; 95% CI, 1.31-3.37). Mortality was higher in patients with neurological involvement (4.4% [95% CI, 4.2%-5.1%] vs 1.3% [95% CI, 1.1%-1.5%]; PϽ.001). At discharge, 159 (2.2%) of 7281 patients had neurological deficits. Conclusions Neurological involvement is common in children in Kenya with acute falciparum malaria, and is associated with metabolic derangements, impaired perfusion, parasitemia, and increased mortality and neurological sequelae. This study suggests that falciparum malaria exposes many African children to brain insults.