Cerebral malaria in adult patients in the Sudan: clinical presentation and outcome

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 Glasgow coma scale. The case fatality was 23%. CM was seen in all age groups. The classical febrile malaria paroxysms were not encountered. The majority of patients developed convulsions and/or psychosis before lapsing into coma. Mortality was higher in patients with modified Glasgow coma scale ? 3, and in those with ocular fundus findings: