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Convulsions in childhood malaria
Y Wattanagoon1, S Srivilairit, S Looareesuwan
1Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Insights
Malaria convulsions in children, even without cerebral malaria, significantly increase fatal outcomes. Plasmodium falciparum malaria is specifically linked to these dangerous convulsions in young children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Malaria remains a significant pediatric health concern, particularly in endemic regions.
- Understanding complications like convulsions is crucial for effective management.
- Cerebral malaria is a known severe manifestation, but non-coma convulsions also warrant investigation.
Purpose of the Study:
- To assess the incidence and outcomes of malaria-related convulsions in children.
- To determine the risk factors and specific Plasmodium species associated with convulsions.
- To evaluate the fatality associated with convulsions in the absence of cerebral malaria.
Main Methods:
- Retrospective survey of 2911 children admitted with malaria.
- Data collected from four provincial hospitals in eastern Thailand (1977-1987).
- Analysis of malaria types (Plasmodium falciparum, P. vivax, mixed) and clinical presentations (cerebral malaria, convulsions, consciousness).
Main Results:
- 3.3% of children had cerebral malaria (22% mortality).
- 7.7% had convulsions without coma (4 deaths).
- Convulsions without coma had a 9.2-fold increased risk of fatality (P=0.004) and were more common in children under 3 and associated with P. falciparum.
Conclusions:
- Convulsions are a critical complication in pediatric malaria, even without coma.
- Plasmodium falciparum infection is significantly associated with malaria-induced convulsions.
- Prompt recognition and management of convulsions are vital for improving outcomes in pediatric malaria cases.
Abstract:
A retrospective survey was conducted of all 2911 children admitted with malaria to 4 provincial hospitals in eastern Thailand between 1977 and 1987. 96 (3.3%) had cerebral malaria of whom 21 (22%) died, 225 (7.7%) had convulsions but were not comatose (4 died), and 2590 were conscious and had no fits (5 died). Thus the relative risk of a fatal outcome associated with convulsions, in the absence of cerebral malaria, was 9.2 (95% confidence interval [CI] = 2.5-34.1), P = 0.004. Overall, Plasmodium falciparum caused 81% of infections, P. vivax 16%, and 3% were mixed. Convulsions without cerebral malaria were more common in children under 3 years old (16%) compared with older children (3%): relative risk 5.6 (95% CI = 4.2-7.5), and were significantly associated with falciparum malaria (8.3%) compared with vivax malaria (4.7%): relative risk 1.7 (95% CI = 1.1-2.7). Convulsions are an important complication of malaria in young children, and are associated specifically with P. falciparum infection, even in otherwise uncomplicated malaria.