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To the Editor: In their study of the burden, risk factors, and magnitude of neurological involvement in acute falciparum malaria in Kenyan children, Dr Idro and colleagues¹ did not consider the use of salicylates in their patient histories. Salicylates are widely available in many African countries and are commonly used for initial management of symptoms that malaria shares with other diseases.² Since salicylate toxicity in African children has been associated with Reye syndrome and has been noted to have many clinical features in common with cerebral falciparum malaria (acidosis, coma, seizure, and hypoglycemia),³ assessing the salicylate plasma concentrations in all children with suspected cerebral malaria and a history of salicylate use is needed to avoid a misdiagnosis.

Financial Disclosures: None reported.

Gabriele Rossi, MD
gab.rossi@tiscali.it
Médecins Sans Frontieres
Cusano Milanino, Italy

1. Idro R, Ndiritu M, Ogutu B, et al. Burden, features, and outcome of neurological involvement in acute falciparum malaria in Kenyan children. JAMA. 2007;297(20):2232-2240. FREE FULL TEXT 2. Clark I, Whitten R, Molyneux M, Taylor T. Salicylates, nitric oxide, malaria, and Reye's syndrome. Lancet. 2001;357(9256):625-627. FULL TEXT | ISI | PUBMED 3. Willcox ML. Salicylates, nitric oxide, malaria, and Reye's syndrome. Lancet. 2001;357(9271):1881-1882. ISI | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298:1274.

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Neurological Involvement in Acute Falciparum Malaria in Kenyan Children—Reply
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Burden, Features, and Outcome of Neurological Involvement in Acute Falciparum Malaria in Kenyan Children
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