Related Experiment Videos
Clinical features and outcome of severe malaria in Gambian children
Insights
Severe falciparum malaria in Gambian children often presents with seizures and cerebral malaria. Key indicators of a fatal outcome include neurological status, hypoglycemia, and hyperlactatemia.
Area of Science:
- Pediatrics
- Infectious Diseases
- Tropical Medicine
Background:
- Severe falciparum malaria is a significant cause of mortality in children in endemic regions.
- Understanding the clinical and laboratory features associated with fatal outcomes is crucial for timely intervention.
Purpose of the Study:
- To investigate the clinical and laboratory characteristics of severe falciparum malaria in Gambian children.
- To identify independent predictors of mortality in pediatric severe malaria.
Main Methods:
- A retrospective study of 180 Gambian children with severe falciparum malaria from 1985 to 1989.
- Clinical data, laboratory findings, and patient outcomes were analyzed using multiple logistic regression.
Main Results:
- Seizures (66%) and cerebral malaria (43%) were common. Respiratory distress predicted a fatal outcome.
- Independent predictors of mortality included coma, advanced parasite stage, elevated pulse/respiratory rates, hypoglycemia, and hyperlactatemia.
- Hepatic and renal dysfunction indicated poor prognosis, but acute renal failure was absent in this pediatric cohort.
Conclusions:
- Neurological status, metabolic derangements (hypoglycemia, hyperlactatemia), and vital sign abnormalities are critical indicators for predicting fatal outcomes in severe pediatric falciparum malaria.
- These findings highlight the importance of close monitoring and prompt management of specific clinical and laboratory parameters in affected children.
Abstract:
The clinical and laboratory features of severe falciparum malaria in 180 Gambian children were studied between 1985 and 1989. Of the 180 children, 118 (66%) presented with seizures, 77 (43%) had cerebral malaria, 35 (20%) had witnessed seizures after admission, 29 (16%) were hypoglycemic, and 27 (15%) died. Respiratory distress was a common harbinger of a fatal outcome. The differences in admission parasite counts in the blood, hematocrit, and opening cerebrospinal pressures for patients who died and survivors were not significant. A multiple logistic regression model identified neurological status (coma, particularly if associated with extensor posturing), stage of parasite development on the peripheral blood film, pulse rate of > 150 or respiratory rate of > 50, hypoglycemia, and hyperlactatemia (plasma lactate level, > 5 mmol/L) as independent indicators of a fatal outcome. Biochemical evidence of hepatic and renal dysfunction was an additional marker of a poor prognosis, but, in contrast to severe malaria in adults, none of these children with severe malaria had acute renal failure.