Q J Med 2003; 96: 688
© 2003 Association of Physicians
Correspondence |
Overdiagnosis of cerebral malaria in patients admitted with neurological dysfunction
Sir,I read with interest the recent article by Makani et al.,1 reporting a gross overdiagnosis of cerebral malaria in patients with acute neurological diseases, resulting in incomplete investigation for alternative aetiologies.
This article is very timely, as the epidemiological patterns of neurological diseases are currently changing in developing countries. Infections and nutritional disorders are on the decline, whereas atherosclerotic and other non-communicable diseases have become more prevalent. The prevalence of cerebral malaria has also decreased. In a recent study from rural India,2 only 15 children out of 2991 admissions (0.5%) were found to have cerebral malaria.
I feel that in an endemic area, it is reasonable to make a provisional diagnosis of cerebral malaria and start empirical therapy in sick patients. However, failure to investigate for alternative aetiologies is not justified, especially in smear-negative cases. A positive smear alone is insufficient for making a diagnosis of cerebral malaria and hence, further work-up should also be done for those smear-positive cases that do not fulfill the WHO criteria for the diagnosis of cerebral malaria.
There is an urgent need to emphasize to physicians the need to investigate for other conditions that are frequently seen in patients with acute neurological dysfunction, such as viral encephalitis, acute disseminated encephalomyelitis (ADEM), metabolic and toxic encephalopathy, and AIDS-related infections. Neurology intensive care units in developing countries need to develop a protocol for acute admissions that investigates for all the above conditions.
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Neurology Unit, Department of Neurological Sciences, Christian Medical College Hospital, Vellore India e-mail: drsudhirkumar{at}yahoo.com
References
1. Makani J, Matuja W, Liyombo E, Snow RW, Marsh K, Warrell DA. Admission diagnosis of cerebral malaria in adults in an endemic area of Tanzania: implications and clinical description. Q J Med 2003; 96:355–62.
2. Kamble MP, Raut PP, Hussain ZF. Cerebral malaria in rural India. Ind J Pediatr 2002; 69:659–61.[Medline]
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