1480. Clinical Characteristics of HIV-infected Children with Fatal Cerebral Malaria
Session: Poster Abstract Session: Global Health
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • ID Week 2013 Clinical Characteristics of HIV Infected Children with Fatal Cerebral Malaria.pdf (543.6 kB)
  • Background:

    Cerebral malaria (CM), defined clinically by P. falciparum parasitemia and coma without other cause, makes up 1-2% of malaria cases but has 15-20% mortality. CM pathology is characterized by sequestration of infected erythrocytes in the cerebral vasculature. The Blantyre Malaria Project (BMP) described 3 patterns of brain pathology in children with clinically defined CM: intravascular parasites alone (CM1, rapid disease), intravascular parasites plus parenchymal ring hemorrhages (CM2, prolonged disease), and no sequestration indicating a non-malarial cause of death (CM3). The HIV rate is higher among autopsies than in the overall CM cohort or general population (20% vs. 13% vs. 2.5%), suggesting HIV is associated with death from CM. 


    To compare clinical characteristics of children with fatal CM with and without HIV co-infection, a retrospective database review was conducted of children who underwent autopsy at BMP from 1996-2009. 10 subjects with CM1, 10 subjects with CM2, and 10 subjects with CM3 pathology were randomly selected; 5 in each group were HIV+. Mean age, BMI, peripheral parasitemia, fever duration, coma score, duration of coma, platelet count, white blood cell count, lymphocyte count, hematocrit, and time to death were compared using Mean Mann-Whitney U-tests. WHO HIV clinical stage was determined for all HIV+ subjects.


    HIV+ children were older than HIV-negative children with CM (mean age 77 months for HIV+ and 38 months for HIV-negative, p=0.009).  There was no difference in age between HIV+ and HIV-negative children with CM3. There was no significant difference in peripheral parasitemia, fever duration, admission coma score, duration of coma, platelet count, or hematocrit between HIV+ and HIV-negative children with CM. Most HIV+ children with CM1 or CM2 pathology had mild immunosuppression by WHO HIV clinical staging. Total lymphocyte counts in the HIV+ children with CM were similar to HIV-negative children with CM.


    Older age at presentation, mild clinical HIV stage and normal lymphocyte counts in children with CM and HIV suggests these children may have immunologic traits that protect them against HIV progression but predispose to CM later in childhood. A prospective study is underway to examine CD4+ T-cells and HIV viral load in co-infected children.

    Theresa Madaline, M.D.1,2, Sarah Hochman, MD2, Terrie Taylor, DO3, Karl Seydel, MD PhD3, Dan Milner Jr., MD4 and Kami Kim, MD, FIDSA2, (1)Montefiore Medical Center, Bronx, NY, (2)Albert Einstein College of Medicine, Bronx, NY, (3)Blantyre Malaria Project, Blantyre, Malawi, (4)Brigham and Women's Hospital, Boston, MA


    T. Madaline, None

    S. Hochman, None

    T. Taylor, None

    K. Seydel, None

    D. Milner Jr., None

    K. Kim, None

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