Neurological involvement in patients with falciparum malaria; frequency and prognostic value

The objective of this study was to evaluate the prognostic significance of neurological manifestations in falciparum malaria.

We analyzed adult patients with malaria admitted from 2001 to 2003, diagnosed by asexual forms of Plasmodium falciparum in peripheral blood films and identified cases of malaria with neurological involvement. A patient was classified as having neurological involvement if they reported or had one or more of the following symptoms; headache, altered mental status, seizures, neck rigidity, brisk reflexes, cranial neuropathy and hyper or hypotonia.

A total of 454 patients were included in the study. Out of these, 123 (27%) were diagnosed as complicated (severe) malaria and 331 (73%) as uncomplicated malaria at admission. Overall 70 (15.4%) patients had evidence of neurological involvement at initial evaluation. Twenty-seven patients out of 123 (22%) with complicated malaria and 43 patients out of 331 (13%) with uncomplicated malaria had neurological involvement. Over all, 16 (4%) patients died, 13 (11%) had complicated malaria (n=123) and 3 (1%) had uncomplicated malaria (n=381). Mortality in patients having neurological involvement (n=70) was 9 (13%) as compared to 7 (2%) in patients with malaria having no neurological involvement (n=384). This difference was statistically significant (p=0.012). Seizure was identified as predictor of mortality on Univariate analysis [OR 5.091 (1.835-14.121)].

Fifteen percent of patients with falciparum malaria admitted to our hospital had neurological symptoms and neurological involvement was associated with increased mortality.