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Children with increased brain volume more likely to die from cerebral malaria
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Increased intracranial pressure may contribute to fatal outcomes among children with cerebral malaria, according to study findings in the New England Journal of Medicine.
“Increased intracranial pressure has long been suspected to contribute to the pathogenesis of cerebral malaria in children,” study researcher Karl B. Seydel, MD, PhD, of Michigan State University, and colleagues wrote. “Uncertainty regarding its role has been exacerbated by disease heterogeneity, underpowered clinical trials, misclassification, and the paucity of large studies comparing the relevant features of patients who survive with the features of those who do not.”
To address these uncertainties, Seydel and colleagues obtained MRI scans for 168 Malawian patients with cerebral malaria, defined as a Blantyre coma score no greater than 2 on a scale from 0 to 5 and peripheral parasitemia with Plasmodium falciparum. Scans were conducted at study enrollment and daily as coma persisted. Study participants were aged older than 5 months.
Twenty-five children died during the study period. Twenty-one of the deaths occurred in patients who had severely increased brain volume at admission; all died due to respiratory arrest consistent with effects of increased intracranial pressure. Three of the four children who died but did not have increased brain volume died from respiratory arrest within 24 hours of admission. These children did not undergo a second MRI scan; therefore, they showed no evidence of a subsequent increase in brain volume.
Thirty-five children underwent a second MRI scan within 30 hours after admission. Results indicated prepontine cerebrospinal fluid levels decreased among children who died, while levels stayed the same or increased among patients who survived (P = .02).
Terrie E. Taylor
“Because we know now that the brain swelling is what causes death, we can work to find new treatments,” study researcher Terrie E. Taylor, DO, of Michigan State University, said in a press release. “The next step is to identify what is causing the swelling and then develop treatments targeting those causes. It is also possible that using ventilators to keep the children breathing until the swelling subsides might save lives, but ventilators are few and far between in Africa at the moment.” – by Amanda Oldt
Disclosure: The study was supported by the National Institute of Allergy and Infectious Diseases and the NIH. Please see the full study for a list of all other relevant financial disclosures.
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