Role of Serum Lactate and Malarial Retinopathy in Prognosis and Outcome of Falciparum and Vivax Cerebral Malaria: A Prospective Cohort Study in Adult Assamese Tribes.
BACKGROUND
There is no comprehensive data or studies relating to clinical presentation and prognosis of cerebral malaria (CM) in the tribal settlements of Assam. High rates of transmission and deaths from complicated malaria guided us to conduct a prospective observational cohort study to evaluate the factors associated with poor outcome and prognosis in patients of CM.


METHODS
We admitted 112 patients to the Bandarpara and Damodarpur Tribal Health Centers (THCs) between 2011 and 2013 with a strict diagnosis of CM. We assessed the role of clinical, fundoscopy and laboratory findings (mainly lactic acid) in the immediate outcome in terms of death and recovery, duration of hospitalization, neurocognitive impairment, cranial nerve palsies and focal neurological deficit.


RESULTS
The case fatality rate of CM was 33.03% and the prevalence of residual neurological sequelae at discharge was 16.07%. These are significantly higher than the previous studies. The mortality rate and neurological complications rate in patients with retinal whitening was 38.46% and 23.07%, with vessel changes was 25% and 18.75%, with retinal hemorrhage was 55.55% and 11.11% and with hyperlactatemia was 53.85% and 18.46%, respectively. Three patients of papilledema alone died.


CONCLUSIONS
Our study suggests a strong correlation between hyperlactatemia, retinal changes (whitening, vessel changes and hemorrhage) and depth and duration of coma with longer duration of hospitalization, increased mortality, neurological sequelae and death. Plasmodium vivax mono-infection as a cause of CM has been confirmed. Prognostic evaluation of CM is useful for judicious allocation of resources in the THC.
Department of Internal Medicine and Infectious Disease, Vanvasi Kalyan Ashram, Kokrajhar, Assam, India.
Kaustubh Suresh
KS
Chaudhari
Department of Internal Medicine, Primary Health Center, Rajur, India.
Sahil Prashant
SP
Uttarwar
Department of Internal Medicine, M.G.M. Medical College, Navi Mumbai, India.
Nikhil Narayan
NN
Tambe
Department of Internal Medicine, Dr. V. M. Government Medical College, Solapur, Maharashtra, India.
Rohan S
RS
Sharma
Department of Preventive and Social Medicine, Navodaya Medical College, Raichur, Karnataka, India.
Anant Arunrao
AA
Takalkar
Assam tribes; cerebral malaria; falciparum; lactic acid; papilledema; prognosis; retinopathy; vivax