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Cerebral Malaria


Presentation

  • Atypical presentation of cerebral malaria can often lead to misdiagnosis. This patient presented with encephalopathic illness with phobic spasms was initially misdiagnosed as human rabies.[ncbi.nlm.nih.gov]
  • To evaluate the magnetic resonance (MR) features of patients with cerebral malaria presenting with altered sensorium. We present the findings in three patients with cerebral malaria presenting with altered sensorium.[ncbi.nlm.nih.gov]
  • One had predominantly meningeal signs while in the other, purely encephalitis features were present. Both cases were treated with artesunate. Rarely, cerebral malaria is a presenting complication or occurs during the course of P. vivax infection.[ncbi.nlm.nih.gov]
  • We present a case of mental status changes secondary to cerebral malaria treated with automated RBCEx resulting in rapid and dramatic neurologic improvement.[ncbi.nlm.nih.gov]
  • This is a retrospective institutional review of clinical data and radiological findings of cerebral malaria patients presenting to a tertiary centre in India, which is an known to be endemic for malarial disease.[ncbi.nlm.nih.gov]
Fever
  • Six of these, treated with quinine responded promptly to therapy with mean parasite and fever clearance times of 58.0 /- 4.9 hrs and 30.0 /- 16.5. hrs respectively and regained consciousness in 20.0 /- 14.5 hrs.[ncbi.nlm.nih.gov]
  • The 27-year-old woman presented with fever, sudden onset of binocular blindness and altered consciousness 10 days after a short stay in Indonesia.[ncbi.nlm.nih.gov]
  • An 84-year-old Somali woman presented with a 3-day history of altered mental status, spiking fevers, chills, bilateral leg pain and weakness, and intermittent diarrhea.[ncbi.nlm.nih.gov]
  • The management of both these cases was complicated because the patients' erythrocytes were glucose-6-phosphate dehydrogenase-deficient, and by the occurrence of blackwater fever, cerebral manifestations, renal impairment, hyperglycaemia and thrombocytopenia[ncbi.nlm.nih.gov]
  • Malaria should always be considered in the differential diagnosis of patients presenting with fever and/or nonspecific flu-like symptoms after traveling to endemic countries.[ncbi.nlm.nih.gov]
High Fever
  • Hot Stage : It is characterized by a high fever up to 107 F (41.7 C) for 3 - 4 hours. Wet Stage : It is characterized by profuse sweating for 2 - 4 hours.[buzzle.com]
  • Hot Stage – This stage is presents with high fever that is developed in patient which is over 107 F (41.7 C) for 3-4 hours.[epainassist.com]
  • Clinical Presentation: Progressive clinical changes occur, along with high fever and chills. Neurologic manifestations are nonspecific because of diffuse involvement of the brain.[ajnr.org]
  • Hot Stage: It is characterised by headaches, vomiting, seizures in young children and high fever i.e. up to 107 F. This may last for 3-4 hours. Sweating Stage: It is characterised by profuse sweating and tiredness. This stage may last for 2-4 hours.[onlymyhealth.com]
Collapse
  • Clinical features  – deep breathing, respiratory distress (acidotic breathing)  – circulatory collapse or shock, systolic blood pressure 70 mm Hg in adults  and 50 mm Hg in children  – clinical jaundice plus evidence of other vital organ dysfunction[slideshare.net]
  • […] syndrome (ARDS), an inflammatory reaction in the lungs that inhibits oxygen exchange, which may occur even after the parasite counts have decreased in response to treatment Abnormalities in blood coagulation Low blood pressure caused by cardiovascular collapse[cdc.gov]
Gangrene
  • After several days of conventional treatment, both developed gangrene involving the feet and toes, but the lesions healed and no other complications were seen.[ncbi.nlm.nih.gov]
Cough
  • Symptoms A malaria infection is generally characterized by the following signs and symptoms: Fever Chills Headache Nausea and vomiting Muscle pain and fatigue Other signs and symptoms may include: Sweating Chest or abdominal pain Cough Some people who[mayoclinic.org]
Vomiting
  • The patient presented with acute confusion and vomiting. His condition deteriorated quickly warranting intubation, ventilation and transfer to intensive therapy unit. Extensive investigation did not find an underlying cause.[ncbi.nlm.nih.gov]
  • Clinical presentations include: headache, altered state of consciousness, seizures, backache, vomiting, nausea, etc.[radiopaedia.org]
  • Hot Stage: It is characterised by headaches, vomiting, seizures in young children and high fever i.e. up to 107 F. This may last for 3-4 hours. Sweating Stage: It is characterised by profuse sweating and tiredness. This stage may last for 2-4 hours.[onlymyhealth.com]
  • After an incubation period of one to four weeks, initial malaria symptoms begin to appear which include fever, headaches, vomiting, chills, and general malaise, similar to the effects of flu.”[hospitals.aku.edu]
Nausea
  • Many people will have a high fever, chills, nausea and body aches. In a symptom very typical of malaria, a patient will experience cyclical … [Read more...][malaria.com]
  • Clinical presentations include: headache, altered state of consciousness, seizures, backache, vomiting, nausea, etc.[radiopaedia.org]
  • Symptoms are non-specific and can include fever, moderate to severe shaking chills, profuse sweating, headache, nausea, vomiting, diarrhoea and anaemia, with no clinical or laboratory findings of severe organ dysfunction.[mmv.org]
  • More commonly, the patient presents with a combination of the following symptoms: Fever Chills Sweats Headaches Nausea and vomiting Body aches General malaise In countries where cases of malaria are infrequent, these symptoms may be attributed to influenza[cdc.gov]
  • Symptoms A malaria infection is generally characterized by the following signs and symptoms: Fever Chills Headache Nausea and vomiting Muscle pain and fatigue Other signs and symptoms may include: Sweating Chest or abdominal pain Cough Some people who[mayoclinic.org]
Leg Pain
  • An 84-year-old Somali woman presented with a 3-day history of altered mental status, spiking fevers, chills, bilateral leg pain and weakness, and intermittent diarrhea.[ncbi.nlm.nih.gov]
Auditory Hallucination
  • A self-limiting psychosis characterized by visual and auditory hallucinations with or without aggressive behavior developed in two children 4 to 5 days after complete recovery from a cerebral malaria coma.[ncbi.nlm.nih.gov]
Seizure
  • Few days later she became drowsy and developed recurrent seizures and marked phobic spasms which prompted the treating physician to diagnose human rabies.[ncbi.nlm.nih.gov]
  • Cerebral malaria is a diffuse encephalopathy associated with seizures and status epilepticus which can occur in up to one-third of children with severe malaria, particularly that caused by Plasmodium falciparum.[ncbi.nlm.nih.gov]
  • Patients are comatose, often with fever, recurrent seizures and this condition is associated with a high mortality rate. The etiology of the coma and seizures are poorly understood.[ncbi.nlm.nih.gov]
  • We report two cases of Plasmodium vivax malaria (both aged 12 years) complicated by seizures and symptoms of diffuse meningoencephalitis. One had predominantly meningeal signs while in the other, purely encephalitis features were present.[ncbi.nlm.nih.gov]
  • If all safety standards are met, dosage will be increased until 75 percent of children are free of seizures for 24 hours (typically, only 20 percent of children admitted with cerebral malaria and seizures are seizure free in the first 24 hours).[msutoday.msu.edu]
Headache
  • Their presenting clinical features, which suggested cerebral malaria (decreased level of consciousness ranging in severity from drowsiness and severe headache to confusion, delirium and even deep coma) may equally characterise hypercyanotic episodes among[ncbi.nlm.nih.gov]
  • Here, we describe the case of a 21-year-old man who presented with fever and headache 13 days after returning from a 12-day trip to Kenya and was subsequently diagnosed with falciparum malaria.[ncbi.nlm.nih.gov]
  • The signs of cerebral malaria include orthostatic hypotension chills, headache, muscle pain, lower blood pressure and altered state of consciousness. Quick Bites Early symptoms are fever and impaired consciousness.[onlymyhealth.com]
  • The main symptoms of cerebral malaria include: persistent orthostatic hypotension chills headache muscle pain low blood pressure altered state of consciousness. In cerebral malaria, attacks may occur every second day and may last for 6-10 hours.[onlymyhealth.com]
  • This infection causes chills, persistent high fever, headache, orthostatic hypotension, myalgia, and red blood cell (RBC) sludging that leads to capillary blockage at several sites.[buzzle.com]
Confusion
  • Their presenting clinical features, which suggested cerebral malaria (decreased level of consciousness ranging in severity from drowsiness and severe headache to confusion, delirium and even deep coma) may equally characterise hypercyanotic episodes among[ncbi.nlm.nih.gov]
  • Here we report an unusual case of a 23-year-old healthy Nigerian man who presented with fever, microangiopathic hemolytic anemia, acute renal failure, and confusion, and was diagnosed as having cerebral malaria-related hemophagocytic lymphohistiocytosis[ncbi.nlm.nih.gov]
  • The patient presented with acute confusion and vomiting. His condition deteriorated quickly warranting intubation, ventilation and transfer to intensive therapy unit. Extensive investigation did not find an underlying cause.[ncbi.nlm.nih.gov]
  • We describe a patient with cerebral malaria who presented with a subarachnoid hemorrhage.Five days after returning from a trip to Kenya, a 54-year-old woman became progressively confused.[nejm.org]
  • Ten days after his return, he developed body aches, confusion progressing to flaccid unresponsiveness, acute liver and renal failure, shock, and thrombocytopenia.[n.neurology.org]
Agitation
  • She initially presented to a local hospital with agitation and over talkativeness and was diagnosed as having an acute psychotic state.[ncbi.nlm.nih.gov]
  • Common symptoms are epileptic seizures, confusion, agitation, disorientation, and coma. Subarachnoid hemorrhage due to plasmodium infection is very rare, 1 but its incidence may be underestimated.[nejm.org]
Stupor
  • He subsequently developed episodes of stupor and refusal of feeding. Following an evaluation by the psychiatrist, a diagnosis of catatonic schizophrenia was made and he was started on oral sulpiride and benhexol.[ncbi.nlm.nih.gov]

Workup

  • Findings strongly suggest that history of malaria should be considered in any medical, psychological, or psychiatric workup of a Vietnam War veteran because a positive response could result in substantial changes in diagnosis and treatment.[scienceblogs.com]
Decreased Oxygen Saturation
  • On admission to the Neurologic Intensive Care Unit in Innsbruck, Austria, SPECT and NIRS revealed focal right hemispheric hypoperfusion and decreased oxygen saturation, respectively, correlating exactly to the patient's right hemispheric localizing signs[ncbi.nlm.nih.gov]

Treatment

  • Antimalarial treatment was initiated based on clinical suspicion despite a negative malarial screen. A rapid response to treatment followed such that the patient was extubated within 24 h.[ncbi.nlm.nih.gov]
  • The remaining three survived with antimalarial and supportive treatment. No neurological symptoms were noted on clinical follow-up.[ncbi.nlm.nih.gov]
  • Abstract Due to delay in treatment, cerebral malaria (CM) remains a significant complication of Plasmodium falciparum infection and is a common cause of death from malaria.[ncbi.nlm.nih.gov]
  • The preparations were inserted into mice as prophylaxis, early or late treatment in the disease course.[ncbi.nlm.nih.gov]
  • Abstract Cerebral malaria (CM) caused by Plasmodium falciparum parasites often leads to the death of infected patients or to persisting neurological sequelae despite anti-parasitic treatments.[ncbi.nlm.nih.gov]

Prognosis

  • Our findings suggest that biopsy of subcutaneous tissue from severe malaria patients may be useful for determining the severity and prognosis of malaria patients.[ncbi.nlm.nih.gov]
  • However, despite the apparently ominous appearance of such lesions in a comatose child, the prognosis seems good.[ncbi.nlm.nih.gov]
  • The advantage of using spectroscopic technique provide important functional information which helps determine the aetiology, pathogenesis, progression, and monitoring of treatment as well as predicting prognosis in the clinical setting of cerebral malaria[ncbi.nlm.nih.gov]
  • Based on a few recent studies carried out in experimental mouse malaria models, we propose a basis for the neurological deficits and sequelae observed in human cerebral malaria, and summarize how existing drugs may improve prognosis in affected individuals[ncbi.nlm.nih.gov]
  • Presence of multiorgan failure makes the prognosis poor. Various mechanisms in the pathogenesis of cerebral malaria and the role of adjuvant therapy will be discussed.[journals.lww.com]

Etiology

  • One theory is that malaria parasites are innocent bystanders in retinopathy-negative CM and the etiology of the coma is entirely non-malarial.[ncbi.nlm.nih.gov]
  • The etiology of the coma and seizures are poorly understood. Circulating small molecules and lipids have bioactive functions and alterations in their concentrations have been implicated in seizure disorders and other forms of encephalopathy.[ncbi.nlm.nih.gov]
  • Cerebral malaria is a form of pernicious malaria, the etiologic factor being the estivo-autumnal parasite, that is, the crescent-forming hemameba.[jamanetwork.com]
  • […] sequences involving the centrum semiovale/corona radiata/periventricular white matter These may have: Restricted diffusion representing infarcts No restricted diffusion, as with this patient, thought to be secondary to an inflammatory/demyelinating etiology[ajnr.org]
  • So, while we do not fully understand the pathology of CM and suspect that it may have multiple etiologies, we do know that it has some differences to, and some overlaps with, other brain inflammatory diseases and we have information about some of the[medscape.com]

Epidemiology

  • Author information 1 International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan; Department of Neurology[ncbi.nlm.nih.gov]
  • Gov't MeSH terms Antigens, CD/blood* Antigens, CD/metabolism Antimalarials/therapeutic use Benin/epidemiology Child, Preschool Endothelial Protein C Receptor Genotype Humans Malaria, Cerebral/blood* Malaria, Cerebral/drug therapy Malaria, Cerebral/epidemiology[ncbi.nlm.nih.gov]
  • 906, Marseille, France Inserm, U906, Marseille, France sandrine.marquet@univ-amu.fr delmiro.fernandez-reyes@ucl.ac.uk. 2 The Francis Crick Institute, Mill Hill Laboratory, London, United Kingdom. 3 Malaria Research and Training Center, Department of Epidemiology[ncbi.nlm.nih.gov]
  • The epidemiological and pathological study of S. E.[ncbi.nlm.nih.gov]
  • KEYWORDS: P. falciparum; cerebral malaria; epidemiology; global health; malarial retinopathy; natural experiment; pathogenesis[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Its pathophysiological mechanisms and clinical manifestations are still currently being studied. Structural imaging techniques such as CT and MRI provide non-specific information during the diagnostic process.[ncbi.nlm.nih.gov]
  • In addition to being a valuable tool for clinical diagnosis, retinal observations give important information about neurovascular pathophysiology in pediatric CM. The Author 2014.[ncbi.nlm.nih.gov]
  • A greater understanding of the pathophysiology of CM would allow the development of adjunctive therapies to improve clinical outcomes.[ncbi.nlm.nih.gov]
  • Investigations to explore the underlying pathophysiologic processes responsible for these MRI changes are warranted. The American Society of Tropical Medicine and Hygiene.[ncbi.nlm.nih.gov]
  • Cerebral malaria (CM) is a major contributor to malaria deaths, but its pathophysiology is not well understood. While sequestration of parasitized erythrocytes is thought to be critical, the roles of inflammation and coagulation are controversial.[ncbi.nlm.nih.gov]

Prevention

  • It appears to prevent murine cerebral malaria through the inhibition of cerebral infiltration of CD8 T cells. 2016 John Wiley & Sons Ltd. KEYWORDS: CD8 T cells; experimental cerebral malaria; prevention; sequestration; tacrolimus[ncbi.nlm.nih.gov]
  • Overall, because of the immunopathological nature of CM, combined immunomodulator/antiplasmodial treatment should be considered for prevention/treatment of human CM and long-term cognitive damage.[ncbi.nlm.nih.gov]
  • A lower bound for the fraction of retinopathy-negative CM that would be prevented if malaria parasitemia were to be eliminated is estimated to be 0.93 (95% confidence interval: 0.68, 1).[ncbi.nlm.nih.gov]
  • This would improve treatment by exposing the parasites for a longer period to a non-toxic drug concentration, high enough to eliminate the pathogen and prevent CM.[ncbi.nlm.nih.gov]
  • Consolidation therapy with oral mefloquine and primaquine was then given to prevent recrudescence and relapse. The only adverse event associated with artesunate was transient reticulocytopenia, which resolved after discontinuation of therapy.[ncbi.nlm.nih.gov]

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