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Clinical study of cerebral malaria in African children
1Department of Pharmacology and Therapeutics, University of Ibadan, Nigeria.
Insights
Cerebral malaria in children often presents with fever and seizures. Promptly addressing renal dysfunction is crucial to reduce mortality and neurological deficits in these pediatric patients.
Area of Science:
- Pediatrics
- Neurology
- Infectious Diseases
Background:
- Cerebral malaria is a severe complication of Plasmodium falciparum infection.
- Pediatric cerebral malaria presents unique clinical challenges and high morbidity/mortality rates.
Purpose of the Study:
- To describe the clinical presentation, neurological signs, and outcomes of pediatric cerebral malaria.
- To identify key factors associated with mortality and long-term neurological deficits.
Main Methods:
- Retrospective analysis of 51 consecutive pediatric cases of cerebral malaria.
- Assessment of presenting symptoms, neurological examination findings, cerebrospinal fluid (CSF) pressure, and laboratory parameters including electrolytes and acid-base status.
- Evaluation of mortality rates and neurological sequelae in survivors.
Main Results:
- Common symptoms included fever, convulsions, and drowsiness; common brain stem signs were decerebrate/decorticate postures and absent corneal reflex.
- Elevated CSF pressure was observed in most patients; hyponatremia occurred in 33%.
- Acute renal failure, particularly the combination of hypercreatininemia and hyperkalemia, was associated with high fatality (5/7). Acid-base disturbances were universal. Mortality was 16%, with 14% of survivors experiencing neurological deficits.
Conclusions:
- Cerebral malaria in children is associated with significant neurological and systemic complications, including elevated CSF pressure and renal failure.
- Early recognition and management of renal dysfunction are critical for improving outcomes.
- Neurological deficits persist in a notable proportion of survivors, highlighting the need for comprehensive care.
Abstract:
Of 51 consecutive children with cerebral malaria, fever, convulsions, and drowsiness were the commonest presenting symptoms. Decerebrate and decorticate postures and absent cornea reflex were the commonest brain stem signs. Opening lumbar cerebrospinal (CSF) pressure was raised in all but one of 24 children in whom it was reliably measured [mean 15.2 +/- 5.7 mmHg, range 6-24]. Hyponatraemia occurred in 17 (33%). Acute renal failure was not uncommon; the combination of hypercreatininaemia (plasma creatinine > 100 mumol/L) and hyperkalaemia (plasma potassium > 6.0 mumol/L) was fatal in 5 out of 7 patients in whom it occurred. Disturbances of acid-base status were present in all 40 children in whom it was assessed on admission. Mortality rate was 16% (8 patients). Neurological deficits occurred in 7 (14%) of the survivors and included cortical blindness [3], aphasia [3], hypertonia [3], hearing loss [2], and dystonia [1]. In addition to the present measures aimed at reducing morbidity and morality in children with cerebral malaria, efforts should be directed at rapid assessment of renal function and prompt correction of such dysfunction if found.