CLINICAL PROFILE AND OUTCOME OF CEREBRAL MALARIA IN A TERTIARY CARE HOSPITAL, KARACHI

Abstract

Background: Cerebral malaria (CM), a severe neurological complication of Plasmodium falciparum infection, remains a major cause of morbidity and mortality in endemic regions. Despite global progress in diagnosis and treatment, CM continues to pose a serious threat in low-resource urban settings such as Karachi, Pakistan, where high population density, inadequate vector control, and delays in medical care increase the disease burden. Early recognition and effective management are crucial to reducing fatal outcomes and long-term neurological sequelae.

Objective: The objective of this study was to assess the clinical presentations, complications, and outcomes of patients with CM at Jinnah Postgraduate Medical Centre (JPMC), Karachi, and to identify predictors of poor prognosis.

Methods: A cross-sectional study was conducted over six months and included 71 patients diagnosed with CM and admitted to Wards 5, 6, 7, and 23 of JPMC. Inclusion criteria required patients to be above 18 years with confirmed Plasmodium falciparum positivity by peripheral blood smear or antigen test. Data were obtained from structured proformas, hospital records, and ward registers. Information on demographics, presenting features, complications, laboratory investigations, treatment received (intravenous fluids, artesunate, quinine), and outcomes was recorded. Statistical analysis was carried out using SPSS; chi-square tests were applied to categorical variables, and independent-sample t-tests were used for continuous variables, with significance set at p<0.05.

Results: Of the 71 patients, 50 (70%) were male and 21 (30%) female. The most affected age group was 21–30 years (37%), followed by 18–20 years (25%). Clinical features included fever in 68 patients (95%), altered consciousness in 60 (85%), coma in 53 (75%), weakness in 57 (80%), and seizures in 29 (41%). Complications recorded were hypoglycemia in 32 (45%), acute kidney injury in 28 (40%), multi-organ failure in 14 (20%), neurological sequelae in 21 (30%), hepatic dysfunction in 7 (10%), and sepsis in 15 (21%). All patients received intravenous fluids, while 60 (85%) were treated with artesunate and 11 (15%) with quinine. Thirty-five (50%) required ICU admission, 18 (25%) needed mechanical ventilation, and 15 (21%) underwent blood transfusion. In terms of outcomes, 50 (70%) recovered completely, 15 (21%) developed neurological sequelae, and 6 (9%) died. Mortality was significantly associated with prolonged coma (p=0.02) and extended hospital stay (p=0.04).

Conclusion: The findings demonstrate that cerebral malaria in Karachi remains a critical public health issue with high rates of complications and neurological sequelae despite standard treatment. Prolonged coma and multi-organ involvement were strong predictors of poor prognosis. Timely diagnosis, prompt initiation of therapy, and improved critical care facilities are essential to reducing mortality. Further research on adjunctive therapies is warranted to mitigate long-term neurological damage.