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Sohaib Ahmad
Nadia Shirazi
Nowneet Kumar Bhat
Minakshi Dhar
Garima Mittal
Manish Mittal
Nidhi Kaeley
Manoj Kumar


severe malaria, cerebral malaria, outcome of malaria


Background & Objectives: Classically associated with Plasmodium falciparum, neurological complications in severe malaria is associated with increased morbidity and mortality. However, reports implicate the long considered benign Plasmodium vivax for causing severe malaria as well. We aimed to analyze the cerebral complications in malaria, and study if there is a specie-related difference in the presentation and outcomes.

Methods: We retrospectively compared patients of malaria hospitalised from 2009-15, with (n=105) and without (n=1155) neurological involvement in terms of outcomes, complications, demographic attributes, clinical features, and laboratory parameters. Subsequently, the same parameters were studied in those with cerebral malaria due to mono-infections of vivax or falciparum and their co-infection.

Results: Cerebral malaria was observed in 8.3% (58/696), 7.4% (38/513) and 17.6% (6/51) of vivax, falciparum and combined plasmodial infections respectively. Those with cerebral malaria had significantly (p<0.05) longer hospitalization, delayed defervescence, required mechanical ventilatory support and dialysis despite comparable levels of azotemia and renal insufficiency, and adverse outcomes compared to non-cerebral malaria. Severe thrombocytopenia, respiratory distress and mechanical ventilation were significantly (p<0.05) associated with P. vivax cerebral malaria.

Conclusions:The plasmodial species were comparable in clinical and laboratory parameters and outcomes in cerebral malaria in isolation and in combination (p>0.05). P. vivax emerged as the predominant cause of cerebral malaria and its virulence was comparable to P. falciparum.


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