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Published on: May 16, 2013
[Criteria of severity in childhood falciparum malaria]
P Imbert1,
1Service des maladies infectieuses et tropicales, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94163 Saint-Mandé, France. hiabegin.mit@worldonline.fr
Insights
Severe pediatric malaria, a significant global health threat, requires prompt recognition. Any child with fever and neurological symptoms after tropical travel needs immediate hospitalization for potential severe malaria.
Area of Science:
- Tropical medicine
- Pediatric infectious diseases
- Global health
Context:
- Severe falciparum malaria causes millions of deaths annually, primarily in African children.
- Imported pediatric malaria cases in France present unique challenges due to rarity and potential severity.
- Established World Health Organization (WHO) criteria for severe malaria may need adaptation for non-endemic, traveling children.
Purpose:
- To evaluate the applicability of current WHO severe malaria criteria in pediatric cases diagnosed in France.
- To identify additional clinical indicators of severity relevant to imported childhood malaria.
- To emphasize the urgency of hospital admission for febrile children with specific symptoms after tropical travel.
Summary:
- The study examines severe malaria in children diagnosed in France, highlighting the limitations of existing WHO criteria for imported cases.
- Key indicators like impaired consciousness, severe anemia, respiratory distress, and hypoglycemia are discussed.
- Thrombocytopenia, dehydration, and bacteremia are proposed as additional factors to consider in imported pediatric malaria.
Impact:
- Refining diagnostic criteria for severe imported malaria in children can improve early detection and treatment.
- Enhanced understanding of severity markers will aid clinicians in managing pediatric malaria cases effectively.
- This research supports timely medical intervention, potentially reducing mortality and morbidity in traveling children exposed to malaria.
Abstract:
Severe falciparum malaria is responsible for 2 million annual deaths, mostly among children under five years living in sub-Saharian Africa. In France, about 1500 paediatric malaria cases are diagnosed each year, among which 1% are severe and 1-2 deaths occur. Children are at high risk for severe forms, since malarial immunity is not yet acquired and symptoms are rapidly progressive. The definition of severe malaria relies upon WHO criteria revised in 2000. In children living in endemic areas, the most frequent criteria are impaired consciousness, severe anaemia, respiratory distress or acidosis, multiple convulsions and hypoglycaemia. Some of them have a high prognostic value, e.g., coma, hypoglycaemia or respiratory distress. The pertinence of WHO criteria was not assessed in travelling children, since severe cases are rare. Other severity criteria found in recent surveys from endemic zones, such as thrombocytopenia or, in infants, dehydration or bacteraemia, should also be investigated in childhood imported malaria. However, any fever associated with a convulsion, prostration, or impaired consciousness, in a child returning from the tropics, should be consider severe malaria and indicate an emergency admission to hospital. In France, intravenous quinine is recommended for the treatment of severe forms, without loading dose in children.
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