Cerebral malaria

Jump to navigation Jump to search

WikiDoc Resources for Cerebral malaria

Articles

Most recent articles on Cerebral malaria

Most cited articles on Cerebral malaria

Review articles on Cerebral malaria

Articles on Cerebral malaria in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Cerebral malaria

Images of Cerebral malaria

Photos of Cerebral malaria

Podcasts & MP3s on Cerebral malaria

Videos on Cerebral malaria

Evidence Based Medicine

Cochrane Collaboration on Cerebral malaria

Bandolier on Cerebral malaria

TRIP on Cerebral malaria

Clinical Trials

Ongoing Trials on Cerebral malaria at Clinical Trials.gov

Trial results on Cerebral malaria

Clinical Trials on Cerebral malaria at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Cerebral malaria

NICE Guidance on Cerebral malaria

NHS PRODIGY Guidance

FDA on Cerebral malaria

CDC on Cerebral malaria

Books

Books on Cerebral malaria

News

Cerebral malaria in the news

Be alerted to news on Cerebral malaria

News trends on Cerebral malaria

Commentary

Blogs on Cerebral malaria

Definitions

Definitions of Cerebral malaria

Patient Resources / Community

Patient resources on Cerebral malaria

Discussion groups on Cerebral malaria

Patient Handouts on Cerebral malaria

Directions to Hospitals Treating Cerebral malaria

Risk calculators and risk factors for Cerebral malaria

Healthcare Provider Resources

Symptoms of Cerebral malaria

Causes & Risk Factors for Cerebral malaria

Diagnostic studies for Cerebral malaria

Treatment of Cerebral malaria

Continuing Medical Education (CME)

CME Programs on Cerebral malaria

International

Cerebral malaria en Espanol

Cerebral malaria en Francais

Business

Cerebral malaria in the Marketplace

Patents on Cerebral malaria

Experimental / Informatics

List of terms related to Cerebral malaria

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Overview

  • 5% of the world’s population is parasitized by malaria at any given time
  • 0.5-2.5 million deaths per year
  • Nearly all deaths (and neurologic complications) caused by Plasmodium falciparum
  • Cerebral Malaria – Case Definition
    • Deep level of unconsciousness with inability to localize a painful stimulus
      • P. falciparum asexual parasitemia
      • Hypoglycemia and other encephalopathies have been excluded
      • Coma should persist >6 hours in adults and >1 hour in children after a seizure

Pathophysiology & Etiology

  • Based on Age and Prior Exposure
    • < 2 years old – severe anemia
    • 2-18 years old – seizures/cerebral malaria
    • >18 years old – acute renal failure, pulmonary edema, liver dysfunction, cerebral malaria
    • All – metabolic acidosis (lactate)
  • Vector
    • Female Anopheles Mosquito
  • What’s in the Smear?
    • Ring forms mostly (occ banana gametocytes) – because trophozoites and schizonts are sequestered in vascular beds, causing pathology
  • Pathology
    • Sequestration of parasitized red blood cells (RBCs) in relatively hypoxic venous beds allows optimal parasite growth and prevents splenic destruction
    • Peripheral parasite count relatively poor predictor of sequestered biomass
    • Parasitized RBCs have electron dense “knobs” on surface, thought to be mediators of cytoadherence
    • Antigenic variation of “knobs” allow immune evasion
    • Decreased deformability of RBCs
    • Increased tumor necrosis factor (TNF) production

History and Symptoms

  • Diffuse encephalopathy
  • Febrile, unconscious, variable tone, usually lacking focal neurologic signs
  • No rash, no lymphadenopathy
  • Hypoglycemia common (8% adults, 20% children)
  • Seizures (10-50%)
  • Mortality 20% (8% ->50% if concomitant with renal failure and metabolic acidosis)
    • Most deaths occur within 48 hours of admission
    • Full recovery of consciousness takes a median of 2 days, but can take >1 week

Treatment

  • Supportive
  • IV Quinine (in US, Quinidine 10-20 mg/kg load followed by 0.02 mg/kg/min drip over 72 hours
  • Blood transfusion for hematocrit < 20
  • Correct hypoglycemia (but does not improve neurologic recovery)

Contraindicated Medications

Future or Investigational Therapies

  • Artemisin derivatives may replace quinine in the future
  • Exchange transfusion?

Template:WS