Getting Your Head around Cerebral Malaria

Dvorin, Jeffrey D.

doi:10.1016/j.chom.2017.10.017

Cited by 10 publications

(9 citation statements)

References 9 publications

(14 reference statements)

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“…Seizures are seen less commonly (15-20% cases) as compared to children. 1,3 This is usually complicated by anemia and jaundice, shock, renal failure, lactic acidosis, coagulation defects and hemoglobinuria. Respiratory difficulties may develop secondary to pulmonary edema and acute respiratory distress syndrome.…”

Section: Malarial Encephalopathy and Associated Clinical Featuresmentioning

confidence: 99%

“…Even though the mortality among patients of cerebral malaria has decreased via the use of effective anti-malarial drugs, it still remains high at 15% to 20%. 3,4 Without treatment, CM is almost always fatal, with about one-fourth surviving cases being afflicted by long term neurological sequelae including epilepsy, sensory and motor abnormalities, and cognitive impairment. 1,4 CM is predominantly seen in low immunity populations such as children growing up in endemic areas, as compared to the adult population.…”

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confidence: 99%

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Cerebral malaria: a lethal complication of a common tropical infection

2021

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Cerebral malaria (CM) represents a deadly neurological complication associated with Plasmodium falciparum infection. It is defined as an unarousable coma or a deep level of unconsciousness in the presence of a P. falciparum parasitemia, the diagnosis confirmed after exclusion of other common causes of coma such as hypoglycemia, septicemia, metabolic derangements and bacterial and viral meningitis/encephalopathies. Mortality is high and some surviving patients sustain neuronal injury which manifests as long-term neuro-cognitive impairments. Microscopy of Giemsa-stained blood smears remains the gold standard for confirmation of malaria diagnosis. The purpose of this review was to summarize the updated knowledge on the disease, its presentation, complications and neurological sequelae and the presently available newer and experimental adjuvant therapies. For this review, a PubMed search was conducted for articles and case reports from 1968 to 2020 containing the keywords cerebral malaria, P. falciparum, neurological impairment, neurocognitive defects and artesunate combination therapy. The treatment includes specific antimalarial therapy, supportive therapy for multi-organ dysfunction and management of associated complications. Prompt and rapid stabilization of the patient, adequate fluid supplementation and correction of electrolyte imbalance remain the most vital supplementary interventions in these cases, along with early induction of primary parenteral antimalarial therapy in the form of artemisinin based combination therapy (ACT) or quinine. Neurological sequelae including seizures are frequently observed in many treated and recovered cases, with some patients having to endure long term neurocognitive defects.

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Section: Malarial Encephalopathy and Associated Clinical Featuresmentioning

confidence: 99%

mentioning

confidence: 99%

Cerebral malaria: a lethal complication of a common tropical infection

2021

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“…Due to these descriptions the importance of BBB was discovered, although the parasites are not able to cross it, they generate a damage of the BBB and an associated hemorrhage that allows the parasitic advance 2 There is a physiopathological model described in 4 phases: [4][5][6]8,11,[18][19][20][21][22] i. Cytoadherence and sequestration of PRC in the cerebral microvasculature…”

Section: Fisiopathology 17mentioning

confidence: 99%

“…Other theories that explain brain injury are: 14,21 Permeability hypothesis: toxic substances generated by the parasite increase the permeability of the BBB, generating edema, coma and death. In contrast, increased intracranial pressure is not common in adults and there is no response to corticosteroids.…”

Section: Fisiopathology 17mentioning

confidence: 99%

Cerebral malaria

Valentim¹

2018

JNSK

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Malaria is one of the main public health problems in endemic areas, with 300 to 500million cases and 1 to 1.5million annual deaths. 4-5,11 It is the first cause of death, of parasitic origin in the entire world. 4 P. falciparum is responsible for 80% of fatal cases hospitalized in endemic areas 4 and neurological complications are found in 50% of children admitted to the hospital. 6 In 2013, an incidence of malaria was estimated to be around 198million cases worldwide and some 575,000 cases of CM were reported, with the African child population being the most affected, 11 with a mortality of 25-30%10. 12,000 cases are considered imported from Europe to Malaria, France being the country with the largest number, about 5,000 cases per year. 5 In one of the retrospective studies conducted in French intensive care centers, where 400 cases of imported severe malaria were received, a mortality of 10% was observed. 5 Imported malaria has an estimated mortality of 10-15%. 5 CM occurs in 2.4% of travelers with malaria to P. falciparum. 6,7 Etiology 1 Anopheles: The bite of the mosquito of the female Anopheles spp. Species infected with P. falciparum transmits the disease to the human being. 2,11 The importance of these vectors lies in being one of the objectives of the malaria control programs. 12 In the mosquito life cycle we distinguish 4 stages: egg, larva, chrysalis and adult. All these phases depend on temperature and nutritional factors, and there is a greater development if temperatures are high. 13 Plasmodium: Malaria is caused by a group of parasites belonging to the genus Plasmodium spp, 2,13 which are protozoa of the Sporozoa class, of the order Eucoccidiida and suborder Haemosporidiida. 13 There are more than 100 species, although only four of them are responsible for Malaria in the human: P. Ovale, P. Malariae, P. Falciparum and P. Vivax. 2,14 The latter two, being responsible for the majority of cases worldwide. 2,13 Within the species responsible for more complications, P. falciparum 4 stands out, with 1% of severe complications that culminated in multi-organ failure. 6,14 P. vivax is responsible for convulsions in children, and also for coma in children and adults. 6

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“…In 2018, more than 228 million cases and more than 400,000 deaths occurred due to malaria, of which about 213 million cases and 380 thousand deaths occurred in Africa. 3,4 Sub-Saharan Africa, in particular, is a high burden region where more than 90% of the global malaria-related mortality occurs. 5 Currently, the major challenge in malaria control and elimination is that most antimalarial drugs (chloroquine, artemether/lumefantrine, quinine, primaquine, etc.)…”

Section: Introductionmentioning

confidence: 99%