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cerebral malaria
Etiology:
- Plasmodium falciparum
- risk factors
a) child under 10 years of age
b) living in malaria endemic area
Pathology:
- sequestration of cerebral capillaries & venules with parasitized (& non parasitized) erythrocytes
- ring-like lesions in the brain (malarial rosetting)
Genetics:
- polymorphisms in CD35 may predispose cerebral malaria
- individuals with sickle cell trait have reduced susceptibility to cerebral malaria
- polymorphisms in ICAM1 may predispose cerebral malaria
Clinical manifestations:
- changes in mental status & coma
- acute in onset
- fever
Laboratory:
- peripheral blood smear for Plasmodium falciparum-pararsitized erythrocytes
Complications:
- 25-50% mortality
Management:
- fatal if not treated in 24-72 hours
- quinine is the mainstay of therapy
- antipyretics to reduce fever
- anticonvulsants, i.e. phenobarbital for seizures
- reduce intracranial pressure with osmotic diuretics
- correct hypoglycemia
- consider exchange transfusion if peripheral parasitemia > 10% of circulating erythrocytes (controversial)
- desferoxamine has antimalarial properties, may reduce formation of reactive oxygen species
- pentoxifylline may be of benefit
General
malaria
References
- Cerebral malaria
http://www.brown.edu/Courses/Bio_160/Projects1999/malaria/cermal.html