cerebral malaria

Etiology

• Plasmodium falciparum
• risk factors
  • child under 10 years of age
  • 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

More general terms

• malaria