Cerbral Malaria

Abstract

ABSTRACT… Cerebral malaria is a disease entity which we commonly come across and that it should be suspected in every patient with impairment of conscious level and high spiking fever especially with no history of trauma. Early treatment is crucial and can be lifesaving. There are two treatment option in which one is conventional Quinine Dihydrochloride and other artmisinin infusion. Objectives: To study the outcomes of Quinine dihydrochloride and artemisinin practice in patients with cerebral malaria in terms of acceptance and response. Methodology: A total of 78 patients fulfilled the inclusion criteria of Glasgow Coma scale (GCS) were of less than 6 for more than 6 hours Defervescence time were 2 to 3 hours after start of treatment Strength of our study is that patients traditional prompt response, with coma multi-organ dysfunction tends to recover and discharge in 4 days. Result: There were total of 78 patient. Out of them 32 (41.0%) were positive for Malaria with 29 (37.1%) were positive for Plasmodium Falciparum and 3 were having Plasmodium Vivax .all were offered treatment with 57 (73.0%) were given Quinine infusion and 21 (26.94%) were treated with artemisinin infusion. Cure rate was 44 (56.4%) with 46 (58.9%) in quinine group and 14 (17.9%) artemisinin group and (19.2%) and 07 (8.9%) respectively making total mortality of 18 (23.0%). There were 9 (11.5%) patients who left against the medical advice. Average age was 26 ±, majority were male. In addition laboratory derangements like alanine amino transferases (ALT), bilirubin, creatinine, electrolytes as potassium and arterial blood gases(ABGs) were also considered. It has been estimated that recovery time of patients was maximum of 72 hours (time of discharge) for both artimisinin and Quinine dihydrochloride. Late responders were also observed. Occasionally persistent of treatment is needed with no fear of drugs resistance. Conclusion: Quinine infusion is generally safe and effective conventional treatment option, whose benefits and acceptance is well known and we are also documenting this. Keywords:Artimisinin; Quinine dihydrochloride; dilemma; cerebral malaria; conventional treatment.