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Pediatric cerebral malaria in Accra, Ghana

C Wolf-Gould1, L Osei, J O Commey

  • 1Department of Medicine, Yale School of Medicine, New Haven, CT 06510.

Journal of Tropical Pediatrics
|December 1, 1991
PubMed

Insights

Diagnosing pediatric cerebral malaria is challenging, with the Glasgow coma scale proving more effective than parasite levels for predicting hospital stay. Autopsy-confirmed cases sometimes lacked detectable parasites.

Area of Science:

  • Tropical Medicine
  • Pediatric Infectious Diseases
  • Clinical Diagnostics

Background:

  • Cerebral malaria diagnosis and treatment efficacy are poorly understood globally.
  • Accurate diagnostic and prognostic tools for pediatric cerebral malaria are needed.

Purpose of the Study:

  • To evaluate the diagnostic and prognostic utility of the Glasgow coma scale (GCS) and parasitaemia levels in pediatric cerebral malaria.
  • To assess the accuracy of initial clinical diagnosis and the response to antimalarial treatment.

Main Methods:

  • Retrospective evaluation of 31 pediatric patients with suspected cerebral malaria at Korle Bu Hospital, Ghana.
  • Analysis of clinical data, including initial diagnosis confirmation rates, Glasgow coma scale scores, and blood parasitaemia levels.
  • Correlation of GCS and parasitaemia with length of hospital stay and treatment outcomes.

Main Results:

  • Only 65% of initial cerebral malaria diagnoses were confirmed; 16% were reclassified (pneumonia, meningitis, encephalitis).
  • Initial Glasgow coma score (mean 10.4) was a stronger predictor of hospital stay (r=0.66) than initial parasitaemia (mean 10^4.6 parasites/mm3, r=0.17).
  • Parasitaemia fluctuated or rose in 33% of patients despite therapy; high parasitaemia correlated with deep coma when assessed longitudinally. Deaths occurred in patients with negative blood smears but autopsy-confirmed cerebral malaria.

Conclusions:

  • Clinical diagnosis of pediatric cerebral malaria has limitations, necessitating further investigation.
  • The Glasgow coma scale is a valuable prognostic index in pediatric cerebral malaria.
  • Diagnostic challenges and treatment responses highlight the need for improved management strategies, especially in cases with negative blood smears.

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