Clinical profile of cerebral malaria at a secondary care hospital

Cerebral malaria (CM) is one of the most common causes for non-traumatic encephalopathy in the world. It affects both the urban and rural population. It is a challenge to treat these patients in a resource limited setting; where majority of these cases present.

This was a prospective study carried out from September 2005 to December 2006 at Jiwan Jyoti Christian Hospital in Eastern Uttar Pradesh in India. This is a secondary level care with limited resources. We studied the clinical profile, treatment and outcome of all the patients above the age of 14 years diagnosed with CM.

There were a total of 53 patients with CM of which 38 (71.7%) of them were females. Among them, 35 (66%) patients were less than 30 years of age. The clinical features noted were seizure (39.62%), anemia (84.9%), icterus (16.98%), hypotension (13.2%), bleeding (3.7%), hepatomegaly (5.66%), splenomegaly (5.66%), non-cardiogenic pulmonary edema (16.98%) and renal dysfunction (37.36%). Co-infection with Plasmodium vivax was present in 13 (24.53%) of them. Treatment received included artesunin compounds or quinine. Median time of defervescence was 2 (interquartile range1-3). Complete recovery was achieved in 43 (81%) of them. Two (3.7%) of them died.

CM, once considered to be a fatal disease has shown remarkable improvement in the outcome with the wide availability of artesunin and quinine components. To combat the malaria burden, physicians in resource limited setting should be well trained to manage these patients especially in the endemic areas. The key to management is early diagnosis and initiation of treatment based on a high index of suspicion. Anticipation and early recognition of the various complications are crucial.