Physiopathologic factors resulting in poor outcome in childhood severe malaria in Cameroon.

Objectives: We evaluated plasma creatinine, urea, bilirubin, lactic acid, and nitric oxide values in children with malaria to identify indices of disease severity and predictors of fatal outcomes.

Methods: Children 0 to 15 years old were recruited, clinical data recorded, and blood samples collected. Plasma creatinine, urea, bilirubin, lactic acid, and nitric oxide (NO) values were determined by spectrophotometry.

Results: Values of creatinine, urea, and bilirubin were normal in all the groups except for urea in some groups (55.30 +/- 5.508 mg/dL and 60.45 +/- 15.56 mg/dL in anemia patients and those with the combined symptoms of cerebral malaria and anemia, respectively). The mean lactate values were high in severe malaria groups (0.57 +/- 0.05 g/L and 0.48 +/- 0.05 g/L in cerebral malaria and anemia patients, respectively). As for the mean NO values, they were above the normal range in all the groups, except the controls, but particularly in the severe malaria groups (68.66 +/- 7.85, 84.52 +/- 8.17, 99.57 +/- 10.48, 87.25 +/- 12.57, and 93.48 +/- 7.09 micromol/L for the control, uncomplicated malaria, anemia, cerebral malaria patients and those with the combined symptoms of cerebral malaria and anemia, respectively; P = 0.643).

Conclusions: In this setting, lactate and NO were indicators of poor prognosis. Though the impact of creatinine, urea, and bilirubin were not found to be significant, they can still be useful to assess improvement in severe malaria cases.