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Journal of Tropical Pediatrics 1992 38(6):290-294; doi:10.1093/tropej/38.6.290
© 1992 by Oxford University Press
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Pediatric Cerebral Malaria in Accra, Ghana

Christopher Wolf-Gould, MD*, Lawrence Osei, MB, ChB(Legon), MPH, FWACP**, J. O. O. Commey, MB, ChB(Legon), FRCP(C), FWACP** and Frank J. Bia, MD, MPH*,

*Department of Medicine, Infectious Disease Section, Yale School of Medicine 333 Cedar Street, New Haven, CT 06510, USA
**Departments of Community Health and Child Health, University of Ghana Medical School Accra, Ghana

Correspondence: Frank J Bia, MD, MPH, Infectious Disease Section, LCI-800, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.

Characteristics of pediatric cerebral malaria, including specificity of clinial diagnosis, efficacy of antimalarial regimens, and the influence of drug resistance remain poorly defined in many parts of the world. The utility of the Glasgow coma scale and quantitative assessment of parasitaemia levels as diagnostic and prognostic indices in cerebral malaria were determined in this study. Thirty-one pediatric patients with admission diagnoses of cerebral malaria in the emergency ward at Korle Bu Hospital, Accra, Ghana were evaluated. Mean age was 4.8 years. The initial diagnosis of malaria was confirmed in 65 per cent of patients; 16 per cent ultimately received another diagnosis including pneumonia, meningitis or encephalitis. In 19 per cent the diagnoses were inconclusive. Mean initial blood parasitaemia level was 104.6 parasites per mm3, and mean initial Glasgow coma score was 10.4. The initial Glasgow score was a better predictor of length of stay (Pearson correlation coefficient r = 0.66) than initial parasitaemia level (r = 0.17). For most treated patients parasitaemia levels decreased a mean of 1.3 logs per day of therapy; however, in 33 per cent parasitaemia continued to rise or fluctuate. High parasitaemia levels were associated with deep levels of coma, but only when both parameters were assessed throughout the hospital stay. Both deaths in this series occurred in patients who had persistently negative blood smears for malaria parasites, but showed autopsy findings consistent with cerebral malaria.


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