Cerebral malaria versus bacterial meningitis in children with impaired consciousness

Cerebral malaria (CM) and acute bacterial meningitis (ABM) are the two comm on causes of impaired consciousness in children presenting to hospital in s ub-Saharan Africa. Since the clinical features of the two diseases may be v ery similar, treatment is often guided by the initial laboratory findings. However, no detailed studies have examined the extent to which the laborato ry findings in these two diseases may overlap. We reviewed data from 555 ch ildren with impaired consciousness admitted to Kilifi District Hospital, Ke nya. Strictly defined groups were established based on the malaria slide, c erebrospinal fluid (CSF) leucocyte count and the results of blood and CSF c ulture and CSF bacterial antigen testing. Our data suggests significant ove rlap in the initial CSF findings between CM and ABM. The absolute minimum p roportions of children with impaired consciousness and malaria parasitaemia who also had definite bacterial meningitis were 4% of all children and 14% of children under 1 year of age. The estimated maximum proportion of all c hildren with impaired consciousness and malaria parasitaemia in whom the di agnosis was dual or unclear was at least 13%. The finding of malaria parasi tes in the blood of an unconscious child in sub-Saharan Africa is not suffi cient to establish a diagnosis of cerebral malaria, and acute bacterial men ingitis must be actively excluded in all cases.