Neurological findings and outcome in adult cerebral malaria.

The neurological findings of 100 patients of adult cerebral malaria were studied. The commonest neurological feature was symmetrical upper motor neuron lesion as evidenced by exaggerated tendon reflexes and bilateral planter extensor (61%). Twenty two percent had features of meningeal irritation and/or meningism. Abnormal posturing occurred decerebrate rigidity (6%) and decorticate rigidity (4%) with or without opisthotonus, focal neurological deficit was noted in 5% cases. Pupillary size and reaction were normal in 86%, poor in 14%. Corneal reflexes were absent in 4% cases. Fundoscopy showed retinal hemorrhage in 16%, papilloedema is 3% and exudates in 1%. Majority of the patients recovered (80%) without any persistent neurological sequelae at the time of discharge from hospital and death rate was 20%. Patients having focal neurological deficit, disconjugate gaze, poor pupillary reaction, absent corneal reflex and papilloedema were more susceptible to death. Delay in hospitalization and deep coma were also associated with increased mortality, whereas early hospitalization and proper nursing care could reduce mortality.

Serosurveillance of Orientia tsutsugamushi and Rickettsia typhi in Bangladesh.

Scrub and murine typhus infections are under-diagnosed causes of febrile illness across the tropics, and it is not known how common they are in Bangladesh. We conducted a prospective seroepidemiologic survey across six major teaching hospitals in Bangladesh by using an IgM enzyme-linked immunosorbent assay. Results indicated recent exposure (287 of 1,209, 23.7% seropositive for Orientia tsutsugamushi and 805 of 1,209, 66.6% seropositive for Rickettsia typhi). Seropositive rates were different in each region. However, there was no geographic clustering of seropositive results for both organisms. There was no difference between those from rural or urban areas. Rickettsia typhi seroreactivity was positively correlated with age. Scrub typhus and murine typhus should be considered as possible causes of infection in Bangladesh.