CORRELATION OF CEREBROSPINAL FLUID BIOCHEMICAL PROFILE WITH CLINICAL FEATURES AND OUTCOME IN CHILDREN WITH CEREBRAL MALARIA SEEN AT THE UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

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CORRELATION OF CEREBROSPINAL FLUID BIOCHEMICAL PROFILE WITH CLINICAL FEATURES AND OUTCOME IN CHILDREN WITH CEREBRAL MALARIA SEEN AT THE UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

Abstract

This is a comparative cross-sectional study on the correlation of CSF biochemical profile and
clinical features and outcome of children with cerebral malaria (CM) compared with children
with febrile convulsion (FC) carried out over a period of one year in the Emergency Paediatric
Unit (EPU) and Paediatric Medical Ward of University of Ilorin Teaching hospital.
Cerebral malaria (CM) continues to be the most severe and life threatening complication of
Plasmodium falciparum infection in children in holoendemic areas. It is also a significant cause
of neurological sequelae and death in children in Sub-Saharan Africa. The changes in the level
of some cerebrospinal fluid (CSF) markers are of immense importance not only in differentiating
CM from infections like meningitis and encephalitis but also in prognosticating the outcome of
children with CM. Cerebrospinal fluid and serum glucose, protein, lactate dehydrogenase, C-
reactive protein, and pH were determined in the children studied in addition to parasite density as
well as clinical features while the outcome was determined at discharge or death.
Thirty six (36) children who satisfied the WHO criteria for CM and their age-matched children
with febrile convulsion were recruited. The male to female ratio were 1.3:1 and 1.1: 1 for CM
and FC respectively. The mean age of children with CM was 3.00 ± 2.16 years while that of FC
was 2.98 ± 1.52 years, hence they are comparable (p = 0.35). The mean haemoglobin
concentration was lower in children with CM (9.15 ± 0.19g/dl) compared to the FC group (10.82
± 0.35g/dl) and this was statistically significant (p = 0.001). Plasmodium parasite count was
observed to be significantly higher in children with CM than those with FC (64.82 ± 26.35
x103/µL and 37.22 ± 0.01 x103/µL respectively, p = 0.001). The mean CSF glucose was
significantly lower in the CM group (3.47 ± 0.39 mmol/L) than in those with FC (4.55 ± 1.14
mmol/L), p = 0.001. The mean CSF CRP and LDH were significantly higher in children with
CM (16.33 ± 10.47 mg/L and 177.67 ± 98.47 U/L) than in those with FC (3.3 ± 0.0 mg/L and 53.4 ±
0.01U /L), p = 0.001. Likewise, mean CSF protein was significantly higher in children with CM
(6.50 ± 4.51mg/dl) than 4.88 ± 0.75 mg/dl in FC (p = 0.001). However, the mean CSF pH was
comparable in both groups of children (p = 0.574).
A positive correlation was observed between full recovery in children with CM and CSF
glucose, CRP and pH (r= 0.134, p = 0.435, r = 0.183, p = 0.286 and r = 0.358, p = 0.032)
respectively while a negative correlation exists between the other CSF parameters (CSF protein
and LDH) and survival with or without sequelae in children with CM (r = -0.107, p = 0.534 and
r= -0.164, p = 0.339) respectively. CSF pH was the only parameter found to have significant
correlation with of children with CM. Three deaths were recorded among the children with CM
while no mortality was recorded from the ones with FC.
In conclusion, children with CM had higher values of CSF CRP, LDH and protein and lower
CSF glucose and pH compared to their counterparts with FC. A significant positive correlation
exits between CSF pH and survival of children with CM while the other CSF markers were not
significantly correlated with outcome. Though, a positive correlation was observed between CSF
glucose, CRP and recovery from CM, the correlation between CSF LDH, protein and outcome
was negative and not significant. Within the limits of this study, CSF glucose, protein, CRP and
LDH may not necessarily be useful in predicting the possible outcome of children with CM.

CORRELATION OF CEREBROSPINAL FLUID BIOCHEMICAL PROFILE WITH CLINICAL FEATURES AND OUTCOME IN CHILDREN WITH CEREBRAL MALARIA SEEN AT THE UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

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