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


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Department of Paediatrics, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. dareoluwayemi@gmail.com
Oludare Isaac
OI
Oluwayemi
Biobele Jotham
BJ
Brown
Olusola Adetunji
OA
Oyedeji
Samuel Ademola
SA
Adegoke
Olusegun Joseph
OJ
Adebami
Gabriel Adebami
GA
Oyedeji
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016779:Malaria, Cerebral / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology*; D009549:Nigeria / Q000453:epidemiology; D011446:Prospective Studies; D013383:Suburban Population; D016019:Survival Analysis; D016896:Treatment Outcome