2. Introduction
Malaria is a parasitic disease caused by protozoans of the Plasmodium genus
There are four main species which are pathogenic to humans; these include Plasmodium
falciparum (P.falciparum), Plasmodium vivax (P.vivax), Plasmodium ovale (P. ovale), and
Plasmodium malariae (P. malariae)
P. falciparum is considered the most dangerous and is responsible for the vast majority of
the high mortality rates associated with Plasmodium infection
Luzolo AL, Ngoyi DM. Cerebral malaria. Brain research bulletin. 2019 Jan 15.
3. Epidemiology
About 216 million cases of malaria
Mortality: 445 000
Eighty percent of the global burden of malaria is accounted for by reports from
just 15 countries, all of which are located in Sub-Saharan Africa, with the
exception of India.
(World Health Organization, 2017)
4. Transmission
Human transmission of Plasmodium occurs during the blood meal of an infected
female mosquito of the Anopheles genus
Luzolo AL, Ngoyi DM. Cerebral malaria. Brain research bulletin. 2019 Jan 15.
5. Severe Malaria
Presence of Plasmodium in peripheral Blood
In addition to clinical or laboratory confirmation of severe vital organ dysfunction
(Idro et al., 2016)
7. Cerebral Malaria
A serious neurological complications induced by infection with P. falciparum (Nanfack, Bilong,
Kagmeni, Nathan, & Bella, 2017)
Around 1 % of children infected with P. falciparum will develop CM(Storm & Craig, 2014)
A leading cause of malaria mortality, responsible for almost 20 % of adult deaths and 15 % of
childhood deaths (Wang, Qian, & Cao, 2015
11 % sequelae - long-term damage from the development of CM (Polimeni & Prato, 2014)
8. Clinical Manifestation
Patient cannot localize a painful stimulus
Has peripheral asexual P. falciparum parasitemia
Has no other identified causes of an encephalopathy
(World Health Organization, 2000)
Generally, patients have a history of a 2 or 3 day fever along with the subsequent abrupt onset of convulsions
and/or severely impaired consciousness
9. Clinical Manifestation
Main Symptoms: headache, muscle pain and altered state of consciousness
Fixed jaw closure and tooth grinding (bruxism)
Motor abnormalities like decerebrate rigidity, decorticate rigidity and
opisthotonos can occur in individuals with CM.
Other symptoms and signs include seizures, enlargement of liver and spleen,
jaundice, pulmonary edema, renal dysfunction, pallor, hypoglycemia, bleeding,
hypotension and severe anemia
(Koshy & Koshy, 2014)
Malaria-specific retinopathy (Taylor et al., 2004)(Birbeck et al., 2010)
10. Malaria-specific Retinopathy
Malignant retinopathy (Seydel et al., 2015)
Reflects the pathological process occurring in the brain including cerebral
sequestration of parasites (Susan Lewallen, Rachel N. Bronzan, Nicholas A. Beare,
Simon P. Harding, Malcolm E. Molyneux, 2008)
The confirmation of a malarial retinopathy is better than any other clinical or
laboratory feature in distinguishing malarial from a non-malarial induced coma
11. Malaria-specific Retinopathy
Retinal whitening
Vessel changes
Retinal hemorrhages
Papilledema
The first two of these abnormalities are specific to malaria
(Beare, N. A., T. E. Taylor, S. P. Harding, 2006)
14. Diagnosis
Should be considered in every comatose patient with a history of fever who has
been in an affected area within the prior two months of symptom onset
Rule out other variables
Asexual forms of P. falciparum present in both the thin and thick stained blood
films/smear
(Dondorp, 2005) (Misra et al., 2011)
16. Treatment
Supportive nursing care
Various antimalarial treatments
Anticipation of complications
Aggressive treatment
Intensive care
(Postels & Birbeck, 2013)
17. Guidelines for the Treatment of Malaria. 2nd edn. WHO, Geneva, 2010
CDC. Guidelines for Treatment of Malaria in the United States (Based on drugs currently available for use in the United States – updated Sep 23, 2011)
Andrej Trampuz, Matjaz Jereb, Igor Muzlovic, Rajesh M Prabhu. Clinical review: Severe malaria. Critical Care2003;7:315-323
18. Andrej Trampuz, Matjaz Jereb, Igor Muzlovic, Rajesh M Prabhu. Clinical review: Severe malaria. Critical Care2003;7:315-323
CDC. Guidelines for Treatment of Malaria in the United States (Based on drugs currently available for use in the United States – updated Sep 23, 2011)
Guidelines for the Treatment of Malaria. 2nd edn. WHO, Geneva, 2010
19. Summary
Malaria is of global health concern mostly in tropical environments
Approximately 1 % of children infected with P. falciparum develop cerebral
malaria
Pathophysiological processes leading to cerebral malaria remain to be fully
elucidated
Retinopathy induced from malaria can serve as a diagnostic test for cerebral
malaria
Cerebral malaria requires systemic health management
