ABSTRACT
In endemic areas adults are less vulnerable to cerebral malaria [CM] than children because of acquisition of partial immunity. This prevalence difference is one of the reasons why we see fewer epidemiological and case studies in adult CM. The objective of this study was to determine the clinical presentation and outcome of CM in adult Sudanese patients. A prospective hospital-based study was conducted in Khartoum Teaching Hospital. Thirty adult Sudanese patients presenting with CM conforming to the World Health Organization [WHO] definition of the disease were recruited. Their presenting features, laboratory investigations and clinical outcome were documented and studied. The mean age at presentation was 32.2 years +/- 15.4 SD. Nineteen patients [63.3%] were males and 11 [36.7%] were females. The predominant initial symptoms of CM were fever, excessive sweating, headache, nausea and vomiting. Before lapsing into coma, 15 patients [50%] manifested psychotic symptoms and 14 [46.7%] developed generalized convulsions. The neurological manifestations appeared after an average of six days from the onset of the febrile illness and reached its nadir within 24 hours. The level of coma was often deep, and 56.6% of patients had scored
ABSTRACT
Although antibodies are essential mediators of immunity, high levels of IgG antibodies against a wide range of blood-stage antigens of P. falciparum are poor predictors of clinical protection. It is the qualitative and the functional specificity of the antibodies to malaria antigens that predict the development of a clinically potent protective immunity. The objective of this work is to study the pattern of IgG sub-class in healthy and malaria-infected adults resident in a malaria-endemic area in Sudan. Total plasma IgG and IgG subclasses [IgG1, 2, 3 and 4] against the C-terminal region of the MSA-1[19] antigen of Plasmodium falciparum were measured by a quantitative enzyme-linked immunosorbent assay [ELISA] in 30 adult patients presenting to the emergency department with cerebral malaria [CM]. The levels of IgG antibody profile in CM patients were compared with those in patients with uncomplicated acute malaria [n=20] and in clinically healthy asymptomatic volunteers [n=20]. Total plasma IgG level was significantly higher in CM patients. The level of the sub-class IgG1 antibody against MSA-119 was significantly lower in patients infected with P. falciparum; the lowest values being observed in CM patients and the highest values in the clinically healthy volunteers. Our data suggest that acquisition of IgG1 antibody to MS A-1[19] is associated with a clinically protective immunity and that low production or defective IgG1 response may be associated with severe form of malaria in adults