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Cerebral malaria in rural India
Milind B Kamble1, Pradeep P Raut, Z F Hussain
1Department of Paediatrics, Shri. Vasantrao Naik Govt. Medical College, Yavatmal, India. milind1732@rediffmail.com
Insights
Cerebral malaria in children presents with fever and neurological symptoms. Prompt diagnosis and treatment of probable cerebral malaria (PCM) are crucial for saving lives in rural settings.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Cerebral malaria is a severe complication of Plasmodium falciparum malaria.
- Fever without a clear focus is common in rural pediatric admissions.
- Understanding the clinical profile and outcomes of cerebral malaria is vital for effective management.
Purpose of the Study:
- To investigate the clinical features and outcomes of cerebral malaria in children in a rural hospital setting.
- To differentiate between definite cerebral malaria (DCM) and probable cerebral malaria (PCM).
Main Methods:
- A cross-sectional study enrolled children meeting inclusion criteria.
- Peripheral smears (PS) were used to diagnose malaria and classify cases as DCM or PCM.
- Clinical data and outcomes were recorded.
Main Results:
- Plasmodium falciparum (PF) was identified in 2.8% and Plasmodium vivax (PV) in 4.3% of malarial cases.
- Fifteen children were included in the study (7 DCM, 8 PCM), predominantly school-aged males.
- Common symptoms included fever, central nervous system (CNS) involvement, convulsions (66.6%), and anemia (60%). Two deaths occurred.
Conclusions:
- Probable cerebral malaria (PCM) should be considered in children with unexplained fever in rural areas.
- Timely and specific therapy for PCM is essential for improving patient outcomes.
- Cerebral malaria is a serious complication, particularly in Plasmodium falciparum malaria cases.
Objective:
A cross-sectional hospital based study was carried out to investigate clinical features and outcome of cerebral malaria in a rural area.
Methods:
All children fulfilling inclusion criteria, were enrolled and were entered on specially designed proforma. Their peripheral smear (PS) were studied based on which the diagnosis was classified as definite cerebral malaria (DCM) and probable cerebral malaria (PCM).
Result:
There were 2991 admissions in pediatric ward, of which 1394 (46.6%) were for fever. Of 781 (56.6%) cases with fever no cause was identified. Of the 56 cases positive for malarial parasite on PS 4.3% were Plasmodium vivax (PV) and 2.8% Plasmodium falciparum (PF). Fifteen patients fulfilled the criteria for study of which 7 were DCM and 8 belonged to PCM group. Twelve (80%) were in school-going age group and M : F ratio was 2 : 1. All patients presented with fever, and CNS involvement, 66.6% had convulsion, 7 developed coma, anaemia was seen in 60%, but only 20% required blood transfusion. Splenomegaly and hepatomegaly was seen in 53.3% and 47% cases respectively. Two patients died, one each in DCM and PCM. Cerebral malaria is a serious complication of severe falciparum malaria and is seen in approximately 32% of PF positive cases.
Conclusion:
PCM is an entity which should be kept in mind when treating fever without definite focus in rural areas, because timely and specific therapy is lifesaving.