Table 3.
Clinical features and initial investigation by malaria parasitaemia and viral CNS infection
|
Malaria parasitaemia |
No malaria parasitaemia |
p value* | ||||||
|---|---|---|---|---|---|---|---|---|
| CNS virus (n=45) | No CNS virus (n=118) | Unadjusted odds ratio (95% CI) | CNS virus (n=88) | No CNS virus (n=262) | Unadjusted odds ratio (95% CI) | |||
| Characteristics | ||||||||
| Male sex | 28 (62%) | 60 (51%) | 1·6 (0·7–3·4) | 52 (59%) | 141 (54%) | 1·2 (0·7–2·1) | 0·479 | |
| Age (months) | 34 (9–72) | 30 (15–50) | 1·0 (1·0–1·0) | 23 (6–78) | 14 (6–48) | 1·0 (1·0–1·0) | 0·001 | |
| Seizures | 32 (71%) | 51 (43%) | 3·2 (1·5–7·4) | 30 (34%) | 91 (35%) | 0·97 (0·6–1·7) | <0·0001 | |
| Generalised | 27 (60%) | 37 (31%) | 3·2 (1·5–7·1) | 25 (28%) | 72 (27%) | 1·0 (0·6–1·8) | <0·0001 | |
| Focal | 6 (13%) | 8 (7%) | 2·1 (0·6–7·4) | 3 (3%) | 15 (6%) | 0·6 (0·1–3·0) | 0·172 | |
| Previous history | 8 (18%) | 8 (7%) | 2·6 (0·8–8·0) | 6 (7%) | 19 (7%) | 1·1 (0·4–3·0) | 0·139 | |
| Unconsciousness | 23 (51%) | 44 (37%) | 2·1 (0·8–8·0) | 13 (15%) | 41 (16%) | 1·4 (0·6–3·0) | <0·0001 | |
| Fever ≥3 days | 16 (36%) | 48 (41%) | 1·6 (0·6–3·8) | 29 (33%) | 95 (36%) | 0·9 (0·5–1·8) | 0·719 | |
| Vomiting | 9 (20%) | 20 (17%) | 1·2(0·4–3·1) | 8 (9%) | 33 (13%) | 0·7 (0·3–1·6) | 0·208 | |
| Diarrhoea | 2 (4%) | 10 (8%) | 0·5 (0·1–2·5) | 8 (9%) | 20 (8%) | 1·2 (0·4–3·0) | 0·841 | |
| Runny nose | 6 (13%) | 5 (4%) | 3·5 (0·8–15·1) | 8 (9%) | 22 (8%) | 1·1 (0·4–2·7) | 0·209 | |
| Headache | 2 (4%) | 14 (12%) | 0·3 (0·0–1·6) | 8 (9%) | 12 (5%) | 1·1 (0·4–2·8) | 0·054 | |
| Examination | ||||||||
| Temperature ≥39°C | 3 (7%) | 19 (16%) | 0·6 (0·4–1·0) | 5 (6%) | 21 (8%) | 1·1 (0·8–1·6) | 0·022 | |
| Deep coma | 27 (60%) | 51 (43%) | 0·5 (0·3–1·0) | 16 (18%) | 50 (19%) | 1·1 (0·8–2·0) | <0·0001 | |
| Bulging fontanelle | 1 (2%) | 1 (1%) | 2·0 (0·1–78·2) | 5 (6%) | 5 (2%) | 3·1 (0·7–13·8) | 0·142 | |
| Neck stiffness | 1 (2%) | 4 (3%) | 0·5 (0·1–4·7) | 6 (7%) | 28 (11%) | 0·6 (0·2–1·6) | 0·044 | |
| Abnormal chest | 3 (7%) | 4 (3%) | 2·0 (0·3–12·5) | 9 (10%) | 10 (4%) | 2·9 (1·0–18·1) | 0·091 | |
| Hepatomegaly | 10 (22%) | 26 (22%) | 0·7 (0·3–2·0) | 5 (6%) | 14 (5%) | 1·1 (0·4–3·5) | <0·0001 | |
| Splenomegaly | 10 (22%) | 22 (19%) | 1·0 (0·4–2·7) | 3 (3%) | 19 (7%) | 0·4 (0·1–1·6) | <0·0001 | |
| Flaccid paralysis | 2 (4%) | 11 (9%) | 0·3 (0·1–1·5) | 1 (1%) | 7 (3%) | 0·4 (0·0–3·3) | <0·0001 | |
| Spastic paralysis | 4 (9%) | 5 (4%) | 2·0 (0·5–8·3) | 6 (7%) | 9 (3%) | 1·9 (0·5–6·8) | 0·442 | |
| Flexor posturing | 3 (7%) | 5 (4%) | 1·4 (0·3–6·3) | 0 | 1 (<1%) | .. | 0·002 | |
| Extensor posturing | 1 (2%) | 2 (2%) | 1·1 (0·1–12·8) | 0 | 3 (1%) | .. | 0·550 | |
| Opisthotonus | 0 | 4 (3%) | .. | 1 (1%) | 7 (3%) | 0·4 (0·0–3·3) | 0·661 | |
| Extensor plantar | 7 (16%) | 16 (14%) | 1·1 (0·4–3·3) | 8 (9%) | 24 (9%) | 1·4 (0·5–3·8) | 0·372 | |
| Observed seizure | 6 (13%) | 6 (5%) | 2·6 (0·7–9·2) | 2 (2%) | 7 (3%) | 0·9 (0·2–4·8) | 0·017 | |
| Investigations | ||||||||
| CSF opening pressure ≥230 cm | 2 (4%) | 5 (4%) | 1·2 (0·2–7·9) | 0 | 1 (<1%) | .. | 0·930 | |
| CSF white cell count >5 per μL | 11 (24%) | 48 (41%) | 0·5 (0·3–1·0) | 31 (35%) | 98 (37%) | 1·1 (0·6–1·8) | 0·501 | |
| HIV positive | 4 (9%) | 10 (8%) | 0·9 (0·2–3·2) | 8 (9%) | 27 (10%) | 0·6 (0·2–1·7) | 0·971 | |
| Outcome | ||||||||
| Died | 17 (38%) | 17 (14%) | 3·6 (1·6–8·0) | 26 (30%) | 34 (13%) | 2·8 (1·6–5·0) | <0·0001 | |
Data are n (%) or median (IQR), unless otherwise stated. CSF=cerebrospinal fluid.
*
Unadjusted comparison across all four groups.