Contribution of plasmodium falciparun and other infections to acute central nervous system disease at the University Teaching Hospital of Lusaka

Three hundred patients presenting with acute central nervous system (CNS) disease were enrolled in this one-year study from June 1997 to June 1998. This was a longitudinal prospective study looking at the contribution of Plasmodium falciparum and other infections to acute central nervous system disease. It also looked at the clinical and laboratory features of patients presenting with acute CNS disease.
The clinical features were vast though most of the patients had a headache (84%), fever (70%) and confusion (40%). The other symptoms included convulsions (17%), weight loss (31%), diarrhoea (40%) while 34% of the patients had given a history of vomiting. The major signs were fever (87%), wasting (64%), meningeal signs (62%), lymphadenopathy (50%), papilloedema (19%), anaemia (54%) and 44% had non-specific macular popular dermatosis.
The study has demonstrated that Plasmodium falciparum is an important cause of acute CNS diseases as 20% of the patients in this study had positive malaria parasite slides. The contribution of other infections were mainly bacteria and it has been shown that Cryptoccoccal neoformans (6.7%), Streptococcus pneumoniae (3.3%), Neisseria meningitides (2.7%), Haemophilus influenzae (0.7%), other bacteria (6.7%) are important causes of acute central nervous system disease. This study population, which had a 1:1 male to female ratio, had a high HIV seroprevalence rate of 75%. The biochemical results did not appear to be helpful except in situations were patients had hypoglycaemia. The RPR results were positive in only 3.3% of the study population. No acid alcohol bacilli were seen or isolated.
The study has demonstrated that Plasmodium falciparum and other infections are an important cause of acute CNS diseases and should therefore always be considered in the management of affected individuals. The range of bacteria pathogens has increased with HIV related infections being common though there was limitation on the range of viral infections.