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

Abstract 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. 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. 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. 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.