title: A Hospital-Based Retrospective Comparative Study of Complications, Outcomes, Clinical and Laboratory Parameters of Malaria with and without Neurological Involvement.
abstract: OBJECTIVE
  Classically associated withPlasmodium (P.) falciparum, neurological complications in severe malaria is associated with increased morbidity and mortality. However, reports implicate the long considered benignP. vivaxfor 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.
  
  
  METHODS
  We 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 ofP. vivaxorP. falciparumand their co-infection.
  
  
  RESULTS
  Cerebral malaria was observed in 8.3% (58/696), 7.4% (38/513) and 17.6% (6/51) ofP. vivax, P. falciparumand 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 withP. vivaxcerebral malaria.
  
  
  CONCLUSIONS
  The plasmodial species are comparable in clinical and laboratory parameters and outcomes in cerebral malaria in isolation and combination (p>0.05).P. vivaxis emerging as the predominant cause of cerebral malaria, and its virulence is comparable toP. falciparum.
authors.affiliation: Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun.
authors.forename: Sohaib
authors.initials: S
authors.lastname: Ahmad
authors.affiliation: Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun.
authors.forename: Nadia
authors.initials: N
authors.lastname: Shirazi
authors.affiliation: Department of Pediatrics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun.
authors.forename: Nowneet K
authors.initials: NK
authors.lastname: Bhat
authors.affiliation: Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun; Presently in Department of Medicine, All India Institute of Medical Sciences, Rishikesh.
authors.forename: Minakshi
authors.initials: M
authors.lastname: Dhar
authors.affiliation: Department of Microbiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun.
authors.forename: Garima
authors.initials: G
authors.lastname: Mittal
authors.affiliation: Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun.
authors.forename: Manish
authors.initials: M
authors.lastname: Mittal
authors.affiliation: Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Kaeley
authors.affiliation: Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun.
authors.forename: Manoj
authors.initials: M
authors.lastname: Kumar
keywords: P. falciparum; P. vivax; acute malaria; cerebral malaria; malaria outcome