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Am. J. Trop. Med. Hyg., 79(4), 2008, pp. 636-642
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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Burden of Cerebral Malaria in Central India (2004–2007)

Vidhan Jain, Avinash C. Nagpal, Pradeep K. Joel, Manmohan Shukla, Mrigendra P. Singh, Rasik B. Gupta, Aditya P. Dash, Saroj K. Mishra, Venkatachalam Udhayakumar, Jonathan K. Stiles, AND Neeru Singh*
National Institute of Malaria Research Field Unit (ICMR), Jabalpur, Madhya Pradesh, India; Nethaji Subhash Chandra Bose Medical College Hospital, Jabalpur, Madhya Pradesh, India; Nethaji Subhash Chandra Bose Medical College Hospital, Jabalpur, Madhya Pradesh, India; National Institute of Malaria Research Field Unit (ICMR), Jabalpur, Madhya Pradesh, India; National Institute of Malaria Research Field Unit (ICMR), Jabalpur, Madhya Pradesh, India; Regional Medical Research Center for Tribals (ICMR), Jabalpur, Madhya Pradesh, India; National Institute of Malaria Research (ICMR), New Delhi, India; Ispat General Hospital, Rourkela, Orissa, India; Malaria Branch, Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; Morehouse School of Medicine, Atlanta, Georgia; Regional Medical Research Center for Tribals (ICMR), Jabalpur, Madhya Pradesh, India

A study on the clinicoepidemiology of cerebral malaria (CM) and mild malaria (MM) among adults and children attending NSCB medical college hospital Jabalpur and civil hospital Maihar, Satna, in central India was undertaken. Of 1,633 patients, 401 were Plasmodium falciparum and 18 P. vivax. Of 401, 199 CM patients and 112 MM patients were enrolled. Severe complications among CM patients were jaundice (26%), acute renal failure (22%), respiratory distress (22%), severe malaria anemia (18%), hypotension (17%), hepatic encephalopathy (7.0%), and hematuria (5%). Among CM cases, seizures and severe malaria anemia were significantly higher in children (P < 0.0001) compared with adults, whereas jaundice (P < 0.0025), acute renal failure (P < 0.0001), and hematuria (P ≤ 0.05) were significantly higher among adults. Mortality was high among adults with multiple organ failures. Overall case fatality rate was 21%. Neurologic sequelae at discharge from the hospital were 3%, whereas at follow-up, only 1% had persistent neurologic sequelae.

Received March 24, 2008. Accepted for publication June 15, 2008.

Acknowledgments: We thank the former Director General, Indian Council of Medical Research, Dr. N. K. Ganguly and other ICMR Head Quarter staff.

Financial support: This study was supported by the National Institute of Health/Fogarty International Center, grant number NIH/FIC R21TW006804-01.

* Address correspondence to Neeru Singh, Regional Medical Research Center for Tribals and National Institute of Malaria Research FU (ICMR) Jabalpur, RMRCT Campus, Nagpur Road, Garha Jabalpur 482001, Madhya Pradesh, India. E-mail: oicmrc{at}yahoo.co.in

Authors’ addresses: Vidhan Jain, National Institute of Malaria Research Field Unit (ICMR), Jabalpur 482001, Madhya Pradesh, India, Tel: 91-761-2425032, E-mail: vidhanjain78{at}yahoo.com. Avinash C. Nagpal, Nethaji Subhash Chandra Bose Medical College Hospital, Jabalpur 482001, Madhya Pradesh, India, Tel: 91-761-5018172, E-mail: nagpal_avinash{at}yahoo.com. Pradeep K. Joel, Nethaji Subhash Chandra Bose Medical College Hospital, Jabalpur 482001, Madhya Pradesh, India, Tel: 91-761-2370444, E-mail: pradeepjoel{at}yahoo.com. Manmohan Shukla, National Institute of Malaria Research Field Unit (ICMR), Jabalpur 482001, Madhya Pradesh, India, Tel: 91-761-2371279, E-mail: mm_shukla57{at}yahoo.co.in. Mrigendra P. Singh, National Institute of Malaria Research Field Unit (ICMR), Jabalpur 482001, Madhya Pradesh, India, Tel: 91-761-2371279, E-mail: mrigendrapal{at}gmail.com. Rasik B. Gupta, Regional Medical Research Center for Tribals (ICMR), Jabalpur 482001, Madhya Pradesh, India, E-mail: rasikbg{at}rediffmail.com. Aditya P. Dash, National Institute of Malaria Research (ICMR), New Delhi, India, E-mail: apdash2{at}rediffmail.com. Saroj K. Mishra, Ispat General Hospital, Rourkela 769005, Orissa, India, E-mail: sarojrkl{at}gmail.com. Venkatachalam Udhayakumar, Malaria Branch, Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, E-mail: vxu0{at}cdc.gov. Jonathan K. Stiles, Morehouse School of Medicine, Atlanta, GA, Tel: 404-752-1585, E-mail: jstiles{at}msm.edu. Neeru Singh, Regional Medical Research Center for Tribals (ICMR), Jabalpur 482001, Madhya Pradesh, India, Tel: 91-761-2672973, E-mail: oicmrc{at}yahoo.co.in.

Reprint requests: Neeru Singh, Regional Medical Research Center for Tribals and National Institute of Malaria Research FU (ICMR) Jabalpur, RMRCT Campus, Nagpur Road, Garha Jabalpur 482001, Madhya Pradesh, India, E-mail: oicmrc{at}yahoo.co.in.






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