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In Reply: Dr Rossi raises a question about the potential influence of salicylate toxicity and Reye syndrome on our estimate of the burden of neurological involvement in children with falciparum malaria. He notes that administration of salicylates to febrile African children is a common practice; exposure to salicylates can predispose to Reye syndrome; metabolic acidosis, respiratory distress, coma, and hypoglycemia are clinical features that are common to salicylate toxicity and Reye syndome as well as cerebral malaria; and suggests that it is therefore necessary to measure salicylate levels in all children with clinical features of cerebral malaria and history of salicylate use to avoid a misdiagnosis between these conditions.

Based on studies we have conducted in Kenya, we believe that in most instances salicylate ingestion is unlikely to have contributed significantly to the pathophysiology of children presenting with malaria coma and acidosis. Among 143 consecutive children admitted to Kilifi District . . . [Full Text of this Article]

Richard Idro, MMED
ridro@kilifi.kemri-wellcome.org

Jane Crawley, MD; Kevin Marsh, MBChB; Charles R. J. C. Newton, MD
Centre for Geographic Medicine Research–Coast
Kenya Medical Research Institute
Kilifi, Kenya

Brian G. R. Neville, FRCP
Neurosciences Unit
The Wolfson Centre
University College London
Institute of Child Health
London, England

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