Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children
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M E Molyneux1, T E Taylor, J J Wirima
1Department of Tropical Medicine, Liverpool School of Tropical Medicine.
Insights
Severe pediatric cerebral malaria in Malawi is predicted by profound coma, seizures, and specific lab markers. A prognostic index combining these factors accurately forecasts patient outcomes, aiding in severity assessment.
Area of Science:
- Pediatric infectious diseases
- Neuroscience
- Malariology
Background:
- Cerebral malaria, a severe complication of P. falciparum infection, poses a significant threat to children in endemic regions.
- Accurate prognostication is crucial for managing pediatric cerebral malaria and understanding disease pathogenesis.
Purpose of the Study:
- To identify presenting clinical and laboratory features associated with adverse outcomes in Malawian children with cerebral malaria.
- To develop and validate a prognostic index for predicting outcomes in pediatric cerebral malaria.
Main Methods:
- A cohort of 131 Malawian children with cerebral malaria was studied.
- A novel method for assessing coma depth in non-verbal children was employed.
- Clinical signs and laboratory parameters were analyzed for their association with mortality and neurological sequelae.
Main Results:
- Fifteen percent of children died, and 9% experienced residual neurological deficits.
- Profound coma, decerebration, absent corneal reflexes, seizures, young age (<3 years), hypoglycemia, leucocytosis, hyperparasitemia, elevated alanine, 5'-nucleotidase, and lactate were linked to adverse outcomes.
- A prognostic index incorporating eight risk factors demonstrated superior predictive accuracy compared to individual features.
Conclusions:
- Clinical and laboratory indicators can effectively predict outcomes in pediatric cerebral malaria.
- A bedside prognostic index can aid in assessing disease severity and comparing patient groups.
- Further research can utilize this index to explore the pathogenesis of cerebral malaria.
Abstract:
We studied the relationship between presenting features and outcome in 131 Malawian children admitted with cerebral malaria (P. falciparum malaria and unrousable coma). A method was devised for the measurement of depth of coma in children too young to speak. Twenty patients (15 per cent) died and 12 (9 per cent) recovered with residual neurological sequelae. Presenting clinical signs significantly associated with adverse outcome (death or sequelae) were profound coma, signs of decerebration, absence of corneal reflexes, convulsions at the time of admission and age under three years. Laboratory findings of prognostic significance were hypoglycaemia, leucocytosis, hyperparasitaemia, elevated plasma concentrations of alanine and 5'-nucleotidase, and elevated plasma or cerebrospinal fluid lactate. A prognostic index based on eight of these risk factors that can readily be ascertained at the bedside or in a ward sideroom, was more accurately predictive of outcome than any single feature. Such an index may be valuable as a measure of severity of illness for establishing the comparability of study groups, and for evaluating the role of other factors in the pathogenesis of cerebral malaria.
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