Annals of African Medicine

RESEARCH LETTER
Year
: 2012  |  Volume : 11  |  Issue : 4  |  Page : 245--246

Clinical presentation and outcome of severe malaria in adults in Zaria, Northern Nigeria


Dimie Ogoina1, Reginald O Obiako2,  
1 Department of Medicine, College of Health Sciences, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria
2 Department of Medicine, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Kaduna State, Nigeria

Correspondence Address:
Dimie Ogoina
Department of Medicine, College of Health Sciences, Niger Delta University, Wilberforce Island, P.M.B. 071 Yenagoa, Bayelsa State
Nigeria




How to cite this article:
Ogoina D, Obiako RO. Clinical presentation and outcome of severe malaria in adults in Zaria, Northern Nigeria.Ann Afr Med 2012;11:245-246


How to cite this URL:
Ogoina D, Obiako RO. Clinical presentation and outcome of severe malaria in adults in Zaria, Northern Nigeria. Ann Afr Med [serial online] 2012 [cited 2022 Jun 27 ];11:245-246
Available from: https://www.annalsafrmed.org/text.asp?2012/11/4/245/102858


Full Text

Sir,

Severe malaria is a life threatening manifestation of malaria caused by Plasmodium falciparum. [1],[2] In Nigeria, intense all year round transmissions of malaria lead to development of partial malarial immunity from childhood that confers protection against severe disease during adolescence and adulthood. [1],[3] However, severe malaria remains a common cause of morbidity and mortality in Nigerian children, and there are only few reports of severe malaria in Nigerian adults, mainly from southern Nigeria. [4],[5]

Out of 3464 adult non-pregnant medical patients admitted between January 2006 and December 2009 in Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, North-West Nigeria, 12 (0.35%) patients fulfilled the WHO 2000 criteria for severe malaria. [2] Severe malaria was defined as presence of all of the following: (1) asexual forms of malaria parasite in thick or thin blood film, (2) one or more clinical or laboratory features of severe malaria (3) absence of other detectable non-malarious causes of presenting clinical features. [2]

The clinical presentations and treatment outcomes of all 12 cases of severe malaria are summarized in [Table 1]. Fever and headache were the most common symptoms observed, while pyrexia and coma (defined as Glasgow coma score- GCS≤9) were the most common signs. Three of these patients were deeply comatose (GCS=3) at presentation. With regard to features of severe malaria, nine patients had multiple convulsions, seven had cerebral malaria and four had impaired consciousness. Other features of severe malaria included extreme weakness in three patients, hyperpyrexia, macroscopic haemoglobinuria and thrombocytopenia in two patients each, and renal failure, jaundice and acute pulmonary edema in one patient each. None of the cases had evidence of hypoglycemia, severe anemia, hypotension or spontaneous bleeding. Laboratory results revealed mild to moderate anemia in three patients, leucocytosis in two patients, and predominant neutrophils with toxic granulations in nine patients. Blood cultures were negative. Only one patient was found to be seropositive for HIV-1 antibodies. While this patient had evidence of AIDS (CD4 cell count=165 cells/μl), convulsions due to intracranial space occupying lesions, such as cerebral toxoplasmosis or brain tuberculoma, were excluded by brain imaging.{Table 1}

Anti-malarial therapy included with intravenous quinine infusion in ten patients and parenteral intramuscular artemether in two patients, according to standard treatment guidelines. [1],[2] Other ancillary management included control of convulsions with diazepam, rehydration with normal saline and O 2 therapy in patients with respiratory distress. Following anti-malarial therapy and other supportive management, nine patients recovered with resolution of fever and regain of full consciousness. None developed neurological sequelae before discharge or at one month of follow up. Three patients with cerebral malaria associated with poor prognostic factors, such as deep coma, pulmonary edema, renal failure and papilloedema, died.

Our results suggest that severe malaria occurs infrequently among adolescents and adults in northern Nigeria. We identified delay in initiation of effective anti-malarial therapy and advanced HIV-1 infection as possible predisposing factors for severe malaria in some of our patients. Future prospective studies are desirable to determine the specific host and parasite risk factors for severe malaria in adult Nigerians.

References

1World Health Organization. Guidelines for Treatment of Malaria 2010. 2 nd ed. WHO; 2010. Available from: http://www.who.int. [Last accessed on 2011 Jul 15].
2World health organization. Severe falciparum malaria. Trans R Soc Trop Med Hyg 2000;94 Suppl 1:1-90.
3Federal Ministry of Health, Nigeria. Nigerian National Malaria Control Programme: 5 year strategic plan 2009- 2013. Available from: http://www.nmcpnigeria.org. [Last cited 2010 Oct].
4Okubadejo NU, Danesi MA. Diagnostic issues in cerebral malaria: A study of 112 adolescents and adults in Lagos, Nigeria. Niger Postgrad Med J 2004;11:10-4.
5Sowunmi A, Walker O, Salako LA. Cerebral malaria in non-paediatrics subjects in south western Nigeria. Afr J Med Med Sci 1993;22:49-53.