Comparative clinical characteristics and response to oral antimalarial therapy of children with and without Plasmodium falciparum hyperparasitaemia in an endemic area

The clinical characteristics and the responses to oral antimalarial therapy of 104 children presenting consecutively with or without Plasmodium falcip arum hyperparasitaemia (HP) were investigated in an endemic area. At presen tation, although the 52 children with HP were significantly younger and had significantly higher heart rates than the 52 without, there were no signif icant differences between the two groups in their symptoms or in any other clinical feature of their malaria. Responses to oral antimalarial drugs wer e similar in both groups. Analysis of the disposition kinetics of parasitae mia, using a non-compartmental model similar to that used in characterizing drug disposition, showed that the two groups had similar half-lives of par asitaemia (t(1/2pd)), volumes of blood completely cleared of parasites per unit time (CLBpd), and parasite-clearance-time:t(1/2pd) ratios. Three child ren in the HP group, all aged <3 years, progressed to cerebral malaria with in 8 h of presentation, and another HP child presented with isolated trunka l ataxia, indicative of cerebellar involvement. No child in the non-HP grou p had any of the features of severe malaria. Although the clinical characte ristics and responses to oral therapy of children with and without HP are t herefore very similar, young children with HP appear to have an increased r isk of developing other features of severe malaria.