Malaria in Children is Associated with a High Rate of Neurological Sequelae and Need for Rehabilitative Therapies in Germany

Abstract

Background

Malaria can cause severe complications including cerebral involvement and long-term neurocognitive impairment, especially in young children. Our study presents data on pediatric malaria cases with a focus on long-term neurological and neurocognitive outcomes following standardized treatment.

Patients and Methods

This retrospective, single-centre study analyzed all pediatric malaria cases treated at our tertiary care hospital in 2023. Follow-ups included neurological examinations, standardized intelligence testing, electroencephalography, and cranial magnetic resonance imaging, with additional assessments provided as needed.

Results

Eleven patients (median age: 9.5 y) were included, with Plasmodium falciparum identified in 91% of cases. Eight (72.7%) patients were diagnosed with severe malaria. Artesunate was used as first-line therapy in 64% of patients. Residual neurological symptoms were observed in 82% of patients. Neurocognitive testing revealed deficits in 44% of the tested patients. Electroencephalographic abnormalities were noted in four patients; three patients developed epilepsies. Cranial magnetic resonance imaging findings included cytotoxic lesions of the corpus callosum and trigonal lesions in three patients. At 12 months, 77.8% of patients showed clinical improvement.

Discussion and Conclusions

Despite prompt, guideline-appropriate treatment, pediatric malaria patients in our cohort exhibited high rates of neurological sequelae requiring rehabilitative and pharmacological treatments. These findings highlight the need for a coordinated follow-up even in non-endemic countries.

Zusammenfassung

Hintergrund

Malaria kann zu schweren Komplikationen mit ZNS-Beteiligung und langfristigen neurologischen Einschränkungen führen, insbesondere bei jungen Kindern. Diese Studie präsentiert Daten von pädiatrischen Malariafällen mit einem Fokus auf die langfristigen neurologischen und neurokognitiven Folgen nach standardisierter Behandlung.

Patienten und Methoden

Daten von Fällen pädiatrischer Malaria von 2023 wurden retrospektiv nach ihrer Behandlung in unserer Klinik analysiert. Verlaufskontrollen umfassten pädiatrisch-neurologische Untersuchungen, standardisierte Intelligenztestungen, Elektroenzephalographien (EEG) und kranielle Magnetresonanztomographien (cMRI), sowie weitere Untersuchungen je nach Bedarf.

Ergebnisse

Elf Patient mit einem medianen Alter von 9,5 Jahren wurden eingeschlossen. Plasmodium falciparum war der verursachende Erreger in 91% der Fälle. Acht (72,7%) Patienten wurden mit komplizierter Malaria diagnostiziert. Als Erstlinientherapie wurde in 64% der Fälle Artesunat eingesetzt. Neurologische Residuen wurden bei 82% der Patienten beobachtet. Intelligenztestungen zeigten Defizite bei 44% der getesteten Patienten. Auffälligkeiten im EEG wurden bei vier Patienten gefunden, drei Patienten eine Epilepsie. Befunde im cMRI umfassten zytotoxische Läsionen des Corpus callosum und Läsionen des Trignoums bei drei Patienten. Nach zwölf Monaten zeigten 77,8% der Patienten eine klinische Besserung.

Diskussion und Schlussfolgerung

Trotz prompter, leitliniengerechter Therapie zeigte pädiatrische Malaria in unserer Kohorte eine hohe Rate von neurologischen Folgeerscheinungen und einen hohen Bedarf an rehabilitativen und pharmakologischen Therapien. Diese Daten heben die Notwendigkeit von koordinierten Verlaufskontrollen auch in nicht-endemischen Ländern hervor.

Schlüsselwörter

Malaria - pädiatrisch - neurologisch - zerebral - Rehabilitation - Verlaufskontrollen

Keywords

Malaria - pediatric - neurological - cerebral - rehabilitation - follow-up

Publication History

Received: 29 July 2025

Accepted after revision: 29 October 2025

Article published online:
06 February 2026

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