title: Burden, features, and outcome of neurological involvement in acute falciparum malaria in Kenyan children.
abstract: BACKGROUND
  Plasmodium falciparum appears to have a particular propensity to involve the brain but the burden, risk factors, and full extent of neurological involvement have not been systematically described.
  
  
  OBJECTIVE
  To determine the incidence and describe the clinical phenotypes and outcomes of neurological involvement in African children with acute falciparum malaria.
  
  
  METHODS
  A review of records of all children younger than 14 years admitted to a Kenyan district hospital with malaria from January 1992 through December 2004. Neurological involvement was defined as convulsive seizures, agitation, prostration, or impaired consciousness or coma.
  
  
  METHODS
  The incidence, pattern, and outcome of neurological involvement.
  
  
  RESULTS
  Of 58,239 children admitted, 19,560 (33.6%) had malaria as the primary clinical diagnosis. Neurological involvement was observed in 9313 children (47.6%) and manifested as seizures (6563/17,517 [37.5%]), agitation (316/11,193 [2.8%]), prostration (3223/15,643 [20.6%]), and impaired consciousness or coma (2129/16,080 [13.2%]). In children younger than 5 years, the mean annual incidence of admissions with malaria was 2694 per 100,000 persons and the incidence of malaria with neurological involvement was 1156 per 100,000 persons. However, readmissions may have led to a 10% overestimate in incidence. Children with neurological involvement were older (median, 26 [interquartile range {IQR}, 15-41] vs 21 [IQR, 10-40] months; P<.001), had a shorter duration of illness (median, 2 [IQR, 1-3] vs 3 [IQR, 2-3] days; P<.001), and a higher geometric mean parasite density (42.0 [95% confidence interval {CI}, 40.0-44.1] vs 30.4 [95% CI, 29.0-31.8] x 10(3)/microL; P<.001). Factors independently associated with neurological involvement included past history of seizures (adjusted odds ratio [AOR], 3.50; 95% CI, 2.78-4.42), fever lasting 2 days or less (AOR, 2.02; 95% CI, 1.64-2.49), delayed capillary refill time (AOR, 3.66; 95% CI, 2.40-5.56), metabolic acidosis (AOR, 1.55; 95% CI, 1.29-1.87), and hypoglycemia (AOR, 2.11; 95% CI, 1.31-3.37). Mortality was higher in patients with neurological involvement (4.4% [95% CI, 4.2%-5.1%] vs 1.3% [95% CI, 1.1%-1.5%]; P<.001). At discharge, 159 (2.2%) of 7281 patients had neurological deficits.
  
  
  CONCLUSIONS
  Neurological involvement is common in children in Kenya with acute falciparum malaria, and is associated with metabolic derangements, impaired perfusion, parasitemia, and increased mortality and neurological sequelae. This study suggests that falciparum malaria exposes many African children to brain insults.
authors.affiliation: Centre for Geographic Medicine Research, Kenya Medical Research Institute/Wellcome Trust Research Labs, Kilifi, Kenya. ridro@kilifi.kemri-wellcome.org
authors.forename: Richard
authors.initials: R
authors.lastname: Idro
authors.forename: Moses
authors.initials: M
authors.lastname: Ndiritu
authors.forename: Bernhards
authors.initials: B
authors.lastname: Ogutu
authors.forename: Sadik
authors.initials: S
authors.lastname: Mithwani
authors.forename: Kathryn
authors.initials: K
authors.lastname: Maitland
authors.forename: James
authors.initials: J
authors.lastname: Berkley
authors.forename: Jane
authors.initials: J
authors.lastname: Crawley
authors.forename: Gregory
authors.initials: G
authors.lastname: Fegan
authors.forename: Evasius
authors.initials: E
authors.lastname: Bauni
authors.forename: Norbert
authors.initials: N
authors.lastname: Peshu
authors.forename: Kevin
authors.initials: K
authors.lastname: Marsh
authors.forename: Brian
authors.initials: B
authors.lastname: Neville
authors.forename: Charles
authors.initials: C
authors.lastname: Newton
mesh_terms: D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007630:Kenya; D016015:Logistic Models; D016779:Malaria, Cerebral / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D010641:Phenotype; D012307:Risk Factors; D016019:Survival Analysis