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Overview :
Children with cerebral malaria in New Guinea differ in clinical
features and complications from children in Africa.
Features of malaria in New Guinea:
(1) intense year-round transmission
(2) cause of 4-17% of deaths in children < 10 years of
age
(3) prevalence of malaria-associated febrile illness and
parasite density with age
Features of pediatric cerebral malaria in New Guinea:
• fatality rate about 12%
• prevalence of residual neurological sequelae at discharge
1.5%
Differences from African children:
(1) lower rate of deep coma
(2) lower rate of hypoglycemia
(3) lower rate of severe complications
(4) lower rate of mortality associated with hypoglycemia on
admission
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Indicators for
mortality |
Odds Ratio |
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malarial anemia (hemoglobin < 5 g/dL or hematocrit <
15% with Plasmodium falciparum parasitemia > 10,000 per µL) |
6.12 |
|
deep coma (Blantyre coma score 0) on admission |
5.12 |
|
prior treatment of some sort |
4.33 |
|
hyperleukocytosis (white blood cell count > 10,000 per
µL) |
3.2 |
|
malnutrition (weight for age Z-score > 2 SD below the
corresponding NCHS reference median) |
2.98 |
|
history < 3 days |
2.26 |
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hypoglycemia (blood glucose < 2.2 mmol/L) |
1.77 |
where:
• < 2 SD in weight would indicate being below the 5th
percentile
Therapeutic recommendations:
(1) correction of shock, hypoglycemia and acidosis
(2) prompt blood transfusion in children with malarial
anemia
(3) control of seizures
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