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

Oluwayemi, Oludare Isaac; Bj, Brown; Oyedeji, Olusola Adetunji; Adegoke, Samuel Ademola; Adebami, Olusegun J.; Oyedeji, GA

doi:10.3855/jidc.2769

Cited by 18 publications

(18 citation statements)

References 9 publications

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“…This result is comparable to reports in a previous study, other African counties, and India showing mortality less than 5% [3,14,18,23]. In contrast, other studies from Uganda and Nigeria reported higher mortality rates (14% and 13.6% respectively) [12,25]. This variation could be related to many factors including late presentation, co-morbidities and quality of local health care.…”

Section: Treatmentsupporting

confidence: 84%

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Pattern of malaria in hospitalized children in Khartoum state

Hashim

Ali

2017

Sudan J Paed

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Malaria remains a major health problem in Sudan with significant morbidity and mortality particularly in children. We prospectively studied children with malaria admitted to an Emergency Department in Khartoum (August-November 2014). Malaria diagnosis was based on a positive blood smear and rapid diagnostic test. The aim was to study the clinical and laboratory features and short-term outcome of malaria among hospitalized children. Data collected from 112 children (males; 56.3%) who fulfilled the criteria for diagnosis of malaria of whom 72.3% had severe malaria and 27.7% uncomplicated malaria (UM). The mean age was 69.2 ± 54.5 months. Hyperparasitemia was detected in 53% of positive blood smears. was detected in 69.4%, in 26.5%, and mixed species in 4.1%. The risk of severe malaria was significantly higher in patients with hyperparasitemia and infection (P = 0.001 and P = 0.014 respectively). Severe malaria cases had significantly higher prevalence of thrombocytopenia and lower mean platelet count than those with UM, P = 0.001 each. Serious complications of severe malaria were cerebral malaria, severe malaria anaemia and acute kidney injury (AKI). The overall case fatality rate was 5.3% and that from severe disease was 4.9%. All deaths were among<60 months-olds and were due to infection with AKI being the only significant risk factor for death (P = 0.045). In Khartoum state, UM is still an important cause of morbidity in children. has emerged as a causative species of severe malaria. The lower mortality rate of malaria probably reflects improvement in health care.

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Section: Treatmentsupporting

confidence: 84%

“…In this study, P. falciparum infection and low-density parasitemia were not statistically significantly associated with CM as has been reported in Cameroon, India, and Nigeria [11,14,25]. We recorded AKI in 7.4% of our children with severe disease.…”

Section: Treatmentsupporting

confidence: 65%

Pattern of malaria in hospitalized children in Khartoum state

Hashim

Ali

2017

Sudan J Paed

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“…The same was observed in NoECMs. High levels of creatinine, observed principally in ECM and NoECM HP rats, have also been reported in children suffering of CM in Africa where hypercreatinemia was reported to be a risk factor of mortality [37,51]. This increase could be linked to renal failure also described in severe malaria [2,52].…”

Section: Resultsmentioning

confidence: 85%

Young Sprague Dawley rats infected by Plasmodium berghei: A relevant experimental model to study cerebral malaria

et al. 2017

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Cerebral malaria (CM) is the most severe manifestation of human malaria yet is still poorly understood. Mouse models have been developed to address the subject. However, their relevance to mimic human pathogenesis is largely debated. Here we study an alternative cerebral malaria model with an experimental Plasmodium berghei Keyberg 173 (K173) infection in Sprague Dawley rats. As in Human, not all infected subjects showed cerebral malaria, with 45% of the rats exhibiting Experimental Cerebral Malaria (ECM) symptoms while the majority (55%) of the remaining rats developed severe anemia and hyperparasitemia (NoECM). These results allow, within the same population, a comparison of the noxious effects of the infection between ECM and severe malaria without ECM. Among the ECM rats, 77.8% died between day 5 and day 12 post-infection, while the remaining rats were spontaneously cured of neurological signs within 24–48 hours. The clinical ECM signs observed were paresis quickly evolving to limb paralysis, global paralysis associated with respiratory distress, and coma. The red blood cell (RBC) count remained normal but a drastic decrease of platelet count and an increase of white blood cell numbers were noted. ECM rats also showed a decrease of glucose and total CO2 levels and an increase of creatinine levels compared to control rats or rats with no ECM. Assessment of the blood-brain barrier revealed loss of integrity, and interestingly histopathological analysis highlighted cyto-adherence and sequestration of infected RBCs in brain vessels from ECM rats only. Overall, this ECM rat model showed numerous clinical and histopathological features similar to Human CM and appears to be a promising model to achieve further understanding the CM pathophysiology in Humans and to evaluate the activity of specific antimalarial drugs in avoiding/limiting cerebral damages from malaria.

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“…While the mortality attributed to malaria in India7 is 0.05%, the figure multiplies manifold in those with cerebral involvement. Mortality in cerebral malaria was reported as 5.5–7% in children in Africa3,8 and 20% in adults in South Asia 9. Concomitant acute renal failure and metabolic acidosis cause a 6-fold increase in mortality suggesting associated vital organ dysfunction has a summative effect on mortality in severe malaria 10.…”

Section: Introductionmentioning

confidence: 99%

A Hospital-Based Retrospective Comparative Study of Complications, Outcomes, Clinical and Laboratory Parameters of Malaria With and Without Neurological Involvement

Ahmad

Shirazi

Bhat

et al. 2016

Mediterr J Hematol Infect Dis

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Background & ObjectivesClassically associated with Plasmodium (P.) falciparum, neurological complications in severe malaria is associated with increased morbidity and mortality. However, reports implicate the long considered benign P. vivax for causing severe malaria as well. We aimed to analyse the cerebral complications in malaria, and study if there is a species-related difference in the presentation and outcomes.MethodsWe retrospectively compared patients with malaria hospitalised from 2009–15, with (n=105) and without (n=1155) neurological involvement regarding outcomes, complications, demographic attributes, clinical features, and laboratory parameters. Subsequently, the same parameters were studied in those with cerebral malaria due to mono-infections of P. vivax or P. falciparum and their co-infection.ResultsCerebral malaria was observed in 8.3% (58/696), 7.4% (38/513) and 17.6% (6/51) of P. vivax, P. falciparum and combined plasmodial infections respectively. Those with cerebral malaria had significantly (p<0.05) longer hospitalisation, delayed defervescence, required mechanical ventilatory support and dialysis despite comparable levels of azotemia and renal insufficiency, and adverse outcomes compared to non-cerebral malaria. Severe thrombocytopenia, respiratory distress and mechanical ventilation were significantly (p<0.05) associated with P. vivax cerebral malaria.ConclusionsThe plasmodial species are comparable in clinical and laboratory parameters and outcomes in cerebral malaria in isolation and combination (p>0.05). P. vivax is emerging as the predominant cause of cerebral malaria, and its virulence is comparable to P. falciparum.

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

Abstract: 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.

Cited by 18 publications

References 9 publications

Pattern of malaria in hospitalized children in Khartoum state

Pattern of malaria in hospitalized children in Khartoum state

Young Sprague Dawley rats infected by Plasmodium berghei: A relevant experimental model to study cerebral malaria

A Hospital-Based Retrospective Comparative Study of Complications, Outcomes, Clinical and Laboratory Parameters of Malaria With and Without Neurological Involvement

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