Burden, features, and outcome of neurological involvement in acute falciparum malaria in Kenyan children.
Burden, features, and outcome of neurological involvement in acute falciparum malaria in Kenyan children.
复制标题
肯尼亚儿童中急性恶性疟疾的神经学参与的负担，特征和结果。
DOI：
10.1001/jama.297.20.2232
复制
发表时间：
2007-05-23
影响因子：
120.7
通讯作者：
Newton, Charles
中科院分区：
文献类型：
--
作者：
Idro, Richard;Ndiritu, Moses;Ogutu, Bernhards;Mithwani, Sadik;Maitland, Kathryn;Berkley, James;Crawley, Jane;Fegan, Gregory;Bauni, Evasius;Peshu, Norbert;Marsh, Kevin;Neville, Brian;Newton, Charles
恶性疟原虫似乎有一种特别的倾向涉及大脑，但其负担、风险因素和神经参与的全面程度尚未得到系统描述。目的：确定非洲儿童急性恶性疟疾的发病率，并描述其神经受累的临床表型和结局。回顾了1992年1月至2004年12月肯尼亚一家地区医院收治的所有14岁以下疟疾儿童的记录。神经系统受累定义为惊厥发作、躁动、虚弱、意识受损或昏迷。神经系统受累的发生率、类型和转归。在58239名住院儿童中，19560名(33.6%)的主要临床诊断为疟疾。神经系统受累9,313例(47.6%)，表现为癫痫(6,563/17,517，37.5%)、躁动(316/11,193，2.8%)、虚弱(3,223/15,643，20.6%)、意识障碍或昏迷(2,129/16,080，13.2%)。在5岁儿童中，疟疾住院的年平均发病率为2694/100,000，与神经系统有关的疟疾发病率为1,156/100,000。然而，重新入院可能导致高估了10%的发病率。有神经系统受累的儿童年龄较大(中位数[四分位数范围]年龄26[15-41]个月比21[10-40]个月，p<；0.001)，病程较短(2[1-3]天比3[2-3]天，p<；0.001)，几何平均寄生虫密度较高(42.0[95%可信区间]比30.4[95%可信区间29.0-31.8]×103/μL，p<；0.001)。与神经系统受累相关的独立因素包括既往癫痫史(调整OR 3.50 95%CI 2.78~4.42)、发热≤2天(调整OR 2.02 95%CI 1.64~2.49)、毛细血管再充盈延迟时间(调整OR 3.66 95%CI 2.40~5.56)、酸中毒(调整OR 1.55 95%CI 1.29~1.87)和低血糖(调整OR 2.11 95%CI 1.32~3.37)。有神经系统受累的患者死亡率较高(4.4%[95%可信区间，4.2%~5.1%]比1.3%[95%可信区间，1.1%~1.5%]，p<；0.001)，出院时有159例(2.2%)有神经功能障碍。神经受累在急性恶性疟疾的儿童中很常见。它与代谢紊乱、血流灌注受损、寄生虫血症有关，并增加了死亡率和神经后遗症。这项研究表明，疟疾使许多非洲儿童受到大脑的侮辱。
Plasmodium falciparum appears to have a particular propensity to involve the brain, but the burden, risk factors and full extent of neurological involvement have not been systematically described. To determine the incidence and describe the clinical phenotypes and outcome of neurological involvement in African children with acute falciparum malaria. A review of records of all children younger than14 years admitted to a Kenyan District Hospital with malaria, from January 1992 through December 2004. Neurological involvement was defined as convulsive seizures, agitation, prostration, impaired consciousness or coma. The incidence, pattern and outcome of neurological involvement. Of 58,239 children admitted, 19,560(33.6%) had malaria as the primary clinical diagnosis. Neurological involvement was observed in 9,313(47.6%) children and manifested as seizures (6,563/17,517, 37.5%), agitation (316/11,193, 2.8%), prostration (3,223/15,643, 20.6%), impaired consciousness or coma (2,129/16,080, 13.2%). In children <5 years, the mean annual incidence of admissions with malaria was 2,694/100,000 and the incidence of malaria with neurological involvement was 1,156/100,000. However, re-admissions may have led to a 10% overestimate in the incidence. Children with neurological involvement were older (median [inter quartile range] age 26[15-41] vs 21[10-40] months, p<0.001), had a shorter duration of illness (2[1-3] vs 3[2-3] days, p<0.001) and a higher geometric mean parasite density (42.0 [95%CI 40.0-44.1] vs 30.4 [95%CI 29.0-31.8]×103/μl, p<0.001). Factors independently associated with neurological involvement included past history of seizures (adjusted OR 3.50 95%CI 2.78-4.42), fever ≤2 days (adjusted OR 2.02 95%CI 1.64-2.49), delayed capillary refill time (adjusted OR 3.66 95% CI 2.40-5.56), acidosis (adjusted OR 1.55 95% CI 1.29-1.87) and hypoglycemia (adjusted OR 2.11 95% CI 1.32-3.37). Mortality was higher in patients with neurological involvement (4.4% [95% CI, 4.2%-5.1%] vs 1.3% [95% CI, 1.1%-1.5%], p<0.001), and at discharge, 159 out of 7281 (2.2%) had neurological deficits. Neurological involvement is common in children with acute falciparum malaria. It is associated with metabolic derangements, impaired perfusion, parasitemia and has increased mortality and neurological sequelae. The study suggests that malaria exposes many African children to brain insults.