Severe falciparum malaria in Gabonese children: clinical and laboratory features

Dzeing-Ella Arnaud, Nze, Tchoua Rose, Planche Timothy, Mboza Béatrice, Mbounja Monique, Muller-Roemer Ulrich, Jarvis Joseph, Kendjo Eric, Ngou-Milama Edouard, Kremsner, Krishna Sanjeev, Kombila Maryvonne

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Malaria continues to claim one to two million lives a year, mainly those of children in sub-Saharan Africa. Reduction in mortality depends, in part, on improving the quality of hospital care, the training of healthcare workers and improvements in public health. This study examined the prognostic indicators of severe falciparum malaria in Gabonese children. Methods An observational study examining the clinical presentations and laboratory features of severe malaria was conducted at the Centre Hospitalier de Libreville, Gabon over two years. Febrile children aged from 0 to 10 years with Plasmodium falciparum infection and one or more features of severe malaria were enrolled. Results Most children presenting with severe falciparum malaria were less than 5 years (92.3% of 583 cases). Anaemia was the most frequent feature of severe malaria (67.8% of cases), followed by respiratory distress (31%), cerebral malaria (24%) hyperlactataemia (16%) and then hypoglycaemia (10%). Anaemia was more common in children under 18 months old, while cerebral malaria usually occurred in those over 18 months. The overall case fatality rate was 9%. The prognostic indicators with the highest case fatality rates were coma/seizures, hyperlactataemia and hypoglycaemia, and the highest case fatality rate was in children with all three of these features. Conclusions Prompt and appropriate, classification and treatment of malaria helps identify the most severely ill children and aids early and appropriate management of the severely ill child.

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• Publié par: biomed
• Publié le: 01 janvier 2005
• Nombre de lectures: 51

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Malaria Journal

BioMedCentral

Open Access Research Severe falciparum malaria in Gabonese children: clinical and laboratory features 1,3 1,3 2 Arnaud DzeingElla , Pascal C Nze Obiang , Rose Tchoua , 4 2 5 Timothy Planche , Béatrice Mboza , Monique Mbounja , Ulrich Muller 6 4 1 7 Roemer , Joseph Jarvis , Eric Kendjo , Edouard NgouMilama , 6 4 1,3 Peter G Kremsner , Sanjeev Krishna and Maryvonne Kombila*

1 Address: Department of Parasitology, Mycology and Tropical Medicine, Faculty of Medicine, University of Health Sciences (USS), Libreville, 2 3 4 Gabon, Department of Paediatrics, Centre Hospitalier de Libreville (CHL), Gabon, Malaria Clinical Research Unit, CHL, Gabon, Department 5 of Infectious Diseases, St. George's Hospital Medical School, Cranmer Terrace, London, UK, Department of Intensive CareEmergency, CHL, 6 7 Gabon, Department of Parasitology, Eberhard Karls Universität, Tübingen, Germany and Department of Biochemistry, Faculty of Medicine, USS, Libreville, Gabon

Email: Arnaud DzeingElla  [e-mail]; Pascal C Nze Obiang  [e-mail]; Rose Tchoua  [e-mail]; Timothy Planche  [e-mail]; Béatrice Mboza  [e-mail]; Monique Mbounja  [e-mail]; Ulrich MullerRoemer  peter.kremsner@unituebingen.de; Joseph Jarvis  [e-mail]; Eric Kendjo  [e-mail]; Edouard NgouMilama  [e-mail]; Peter G Kremsner  peter.kremsner@unituebingen.de; Sanjeev Krishna  [e-mail]; Maryvonne Kombila*  [e-mail] * Corresponding author

Published: 09 January 2005 Received: 20 June 2004 Accepted: 09 January 2005 Malaria Journal2005,4:1 doi:10.1186/1475-2875-4-1 This article is available from: http://www.malariajournal.com/content/4/1/1 © 2005 Ella et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Background:Malaria continues to claim one to two million lives a year, mainly those of children in sub-Saharan Africa. Reduction in mortality depends, in part, on improving the quality of hospital care, the training of healthcare workers and improvements in public health. This study examined the prognostic indicators of severe falciparum malaria in Gabonese children. Methods:An observational study examining the clinical presentations and laboratory features of severe malaria was conducted at the Centre Hospitalier de Libreville, Gabon over two years. Febrile children aged from 0 to 10 years withPlasmodium falciparuminfection and one or more features of severe malaria were enrolled. Results:Most children presenting with severe falciparum malaria were less than 5 years (92.3% of 583 cases). Anaemia was the most frequent feature of severe malaria (67.8% of cases), followed by respiratory distress (31%), cerebral malaria (24%) hyperlactataemia (16%) and then hypoglycaemia (10%). Anaemia was more common in children under 18 months old, while cerebral malaria usually occurred in those over 18 months. The overall case fatality rate was 9%. The prognostic indicators with the highest case fatality rates were coma/seizures, hyperlactataemia and hypoglycaemia, and the highest case fatality rate was in children with all three of these features. Conclusions:Prompt and appropriate, classification and treatment of malaria helps identify the most severely ill children and aids early and appropriate management of the severely ill child.

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