Guillain-Barré syndrome following acute falciparum malaria.

Plasmodium falciparum malaria is often complicated by involvement of the gastrointestinal, cardiovascular, and nervous systems. The development of Guillain-Barré syndrome in 10 patients who had had acute P. falciparum malaria during its seasonal exacerbation is reported.

Parasite diversity in adult patients with cerebral malaria: a hospital-based, case-control study.

Thirty adult patients with cerebral malaria (CM) were recruited for this study. Two clinical groups were used as controls: those with mild malaria (n = 20) and asymptomatic volunteers (n = 20). Thick and thin blood smears were examined for detection of Plasmodium falciparum and estimating infection intensity. A nested polymerase chain reaction (PCR) using allele-specific primers for merozoite surface protein gene was used to determine the parasite diversity of Plasmodium falciparum causing CM. Plasmodium falciparum was detected in blood smears of all malaria patients. No significant difference in parasite count was found between the groups. Thirteen (65%) of the asymptomatic volunteers had a positive PCR for P. falciparum. Multiple alleles were found in 17 (58.6%) patients with CM, but only in 7 (35.6%) with uncomplicated malaria. Multiple alleles were also found in 6 (46.2%) of the 13 PCR-positive asymptomatic individuals. We could not identify a specific strain or strains of P. falciparum that showed a significant association with disease severity. Therefore, we assume that the development of CM in adults residing in endemic areas is more dependent on strain multiplicity rather than on a specific strain or strains of P. falciparum, and that the parasite intensity has no relationship with disease severity. Asymptomatic adults may repeatedly be exposed to low levels of a wide range of different strains during low transmission season and acquire sub-patent parasitemia. This may also confer premunition that renders them relatively resistant to CM.

Acute stroke type, risk factors, and early outcome in a developing country: a view from Sudan using a hospital-based sample.

This hospital-based prospective study was conducted to determine stroke type, risk factors, and early outcome in patients admitted with acute stroke in both Khartoum and Shaab hospitals located in the capital city of Sudan. Consecutive stroke patients presenting within 48 hours of onset were included in the study. Data were obtained from history taking, physical examination, and investigations. Cranial computed tomography (CT) scanning was performed on 18 patients. The diagnosis of stroke type in patients who did not have CT examination was determined by clinical criteria. Ninety-six patients, 56 males and 40 females, were studied. The peak age group was 61 to 80 years. Stroke caused by infarction was found in 58.3% while stroke caused by hemorrhage was found in 41.6%. Hypertension was the most common associated risk factor, constituting 46.9%. Cardiac disease was found in 16%, diabetes mellitus in 14.6%, syphilis in 4.1%, and previous transient ischemic attack in 2.1%. The overall mortality was higher than in western countries. Risk factors for stroke in Sudan are the same as elsewhere; however, the peak age group is one decade earlier than in developed countries. In developing countries, promoting hypertension and acute stroke health care programs are essential to cutting morbidity and mortality rates.