Clinical and laboratory predictors of outcome in cerebral malaria in suburban Nigeria

Oludare Isaac Oluwayemi,Samuel Ademola Adegoke,Olusola Adetunji Oyedeji,Olusegun Joseph Adebami,Gabriel Adebami Oyedeji,Biobele Jotham Brown

doi:10.3855/jidc.2769

Abstract

Cerebral malaria (CM) is an important cause of morbidity and mortality among children living in the tropics. The present study was conducted to update the knowledge on cerebral malaria in children. This was a prospective study conducted between June 2009 and February 2010. Consecutive children who met the clinical and parasitological diagnostic criteria for CM were admitted and studied. Demographic, essential history, clinical examination findings and laboratory results were recorded and analyzed. Outcome in survivors (presence or absence of neurological deficits) were determined at discharge. Out of 1,202 children admitted during the study period, 66 (5.5%) had CM: 40 boys and 26 girls. Ages ranged from 2 to 128 months (mean: 41.6 ± 27.1 months). Fever (100%), coma (100%) and convulsion (89%) were the commonest presenting symptoms, while unsteady gait, speech, auditory and visual impairment were the commonest neurological deficits at discharge. Fifty-seven (86.4%) patients survived while nine (13.6%) died. Of the 57 survivors, 35 (61.4%) recovered completely, while 22 (38.6%) had neurological deficits at discharge. Identified clinical and laboratory predictors of mortality in CM included: age less than 3 years (p = 0.031), abnormal breathing pattern (p = 0.023), absent corneal reflex (p = 0.005), absent pupillary reflex (p = 0.047), retinal haemorrhage (p = 0.029), hypoglycaemia (p = 0.002) and leucocytosis (p = 0.040). CM is associated with high mortality and serious sequelae. Affected children should be given proactive management and monitored closely to reduce the frequency of adverse outcomes.

Highlights

Cerebral malaria (CM) is an important cause of morbidity and mortality among children living in the tropics
Of the 1,202 patients (657 males and 545 females) admitted during the study period, 66 (5.5%) children had CM and 268 other children were treated for other forms of severe malaria
The proportion of children admitted for malaria who had CM in the present study is, higher than the 6.3% reported by Meremikwu et al in Calabar, Nigeria [12]

Summary

Introduction

Cerebral malaria (CM) is an important cause of morbidity and mortality among children living in the tropics. The present study was conducted to update the knowledge on cerebral malaria in children. Identified clinical and laboratory predictors of mortality in CM included: age less than 3 years (p =0.031), abnormal breathing pattern (p = 0.023), absent corneal reflex (p = 0.005), absent pupillary reflex (p = 0.047), retinal haemorrhage (p = 0.029), hypoglycaemia (p = 0.002) and leucocytosis (p = 0.040). A common cause of morbidity and mortality among children, constitutes 25% to 40% of all outpatient clinic visits and 21% of hospital admissions in sub-Saharan Africa with over one million dying annually [1]. Cerebral malaria (CM) is the most severe neurological presentation of acute falciparum malaria. It is a diffuse encephalopathy associated with seizures in at least 80% of patients [2]. Uncontrolled seizure activity, including nonconvulsive seizure, is known to damage the brain by aggravating hypoxia, hypoglycaemia and intracranial hypertension [5]

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Results

Conclusion