Neurologic Sequelae after Severe Falciparum Malaria in Adult Travelers

Abstract

Severe falciparum malaria usually occurs in nonimmune patients, namely children in endemic areas or travelers returning from tropical areas. It generally has one of two outcomes: rapid death or cure without sequelae. Neurologic sequelae have been reported in children but have not been described in detail in adults. The purpose of this study was to determine the clinical spectrum, neuroimaging aspects and long-term outcome of these sequelae. We describe six imported cases of severe malaria with neurologic sequelae in adults, seen in a Parisian university hospital over a 10-year period. The most striking findings were neuropsychological disorders, in particular memory impairment and diffuse white matter damage on magnetic resonance imaging. Only three of the patients had made a full recovery after 6 months.

Tissue-specific immunopathology during malaria infection

“…Such factors may affect not only cerebral malaria, in which P. falciparum parasites are known to be sequestrated in the brain vessels and retina of humans 11 , but also the pathology in other organs that are characterized by high levels of iRBC seques tration, including the gastrointestinal tract, lungs, kidneys and skin [11][12][13] . Importantly, these complications could leave survivors with long-term health problems such as cognitive and neurological deficits 14,15 .…”

Malaria and hypertension. Another co-evolutionary adaptation?

“…Nonimmune malaria patients, such as travelers, are more susceptible to succumb to CM and develop neurological sequelae (Alrajhi et al, 1999; Roze et al, 2001). But not all nonimmune travelers have the same odds to develop malaria complications.…”

Adjunctive therapy for cerebral malaria and other severe forms ofPlasmodium falciparummalaria

“…Importantly, African children who survive the acute episode of CM often have long-term cognitive (~25%) [11,12] and neurologic (1.1–4.4%) [11,13] deficits. There is some evidence of neuropsychiatric problems after CM in adults in Asia [14], but neither neuropsychiatric or cognitive problems have been studied systematically in these populations.…”