Health - Cerebral Malaria

A close relation of mine fell ill some time ago. The family didn't tell anyone about her illness because they initially thought it was spiritual.

After taking her to a few hospitals without any doctor being able to tell what was wrong with her, they took her to the Lagos state teaching hospital (luth), where she's presently receiving treatment.

Some days ago, her older sister called my mum to tell her about the situation. The sick patient had asked to see some of us because she was convinced the illness would kill her.

On Wednesday, my mum, my sister and I went to visit her and immediately she saw us, she started crying. We all started crying. Off all the people in her family, she was the closest to us, the one we loved most. And to see her in that situation was extremely hard to take in.

Not only could she not walk, eat, talk audibly, stand, or sit on her back, she was hallucinating. She told us she sees things at night...snakes, lions, witches...all trying to kill her. Her younger brother told us that the hospital staff had to tie her hands and legs the previous night because she woke up the that night screaming uncontrollably. Our dear friend was beginning to loose her mind.

I asked her brother what was wrong with her and they said malaria. Malaria I asked? I've had malaria before and I didn't go mad...what kind of malaria is this? A doctor came before we left and told us it's called CELEBRAL MALARIA. Never heard of it before. Never met anyone who had it...it was hard for me to believe that malaria could paralise and make one go almost insane.

So I decided to go research about this kind of malaria and this was what I found...

Celebral Malaria

What is cerebral malaria?
Cerebral malaria (CM) collectively involves the clinical manifestations of Plasmodium falciparum malaria that induce changes in mental status and coma. It is an acute, widespread disease of the brain which is accompanied by fever.

The mortality ratio is between 25-50%. If a person is not treated, CM is fatal in 24-72 hours. The histopathological hallmark of this encephalopathy is the sequestration of cerebral capillaries and venules with parasitized red blood cells (PRBCs) and non-PRBCs (NPRBCs). Ring-like lesions in the brain are major characteristics.

There is a clear need for a strict definition of cerebral malaria in order to properly diagnose and assess the condition. A pragmatic definition based on the Glasgow Coma Score exists. Its key elements are:
(1) unrousable coma--no localizing response to pain persisting for more than six hours if the patient has experienced a generalized convulsion;
(2) asexual forms of P. falciparum found in blood; and
(3) exclusion of other causes of encephalopathy, i.e. viral or bacterial.


What are the symptoms?
Clinical manifestations of cerebral malaria are numerous, but there are three primary symptoms generally common to both adults and children:
(1) impaired consciousness with non-specific fever;
(2) generalized convulsions and neurological sequelae; and
(3) coma that persists for 24-72 hours, initially rousable and then unrousable.

What is the cause?
The cause of cerebral malaria is not well understood. Currently, there are two major hypotheses explaining its etiology. They are the mechanical and the humoral hypotheses.

The mechanical hypothesis asserts that a specific interaction between a P. falciparum erythrocyte membrane protein (PfEMP-1) and ligands on endothelial cells, such as ICAM-1 or E-selectin, reduces microvascular blood flow and induces hypoxia. This selective cytoadherence of PRBCs and non-PRBCs, also known as rosetting, can apparently better account for CM’s histopathological hallmark and its characteristic coma condition. However, this hypothesis is inadequate in explaining the relative absence of neurological deficit even after days of unconsciousness.

The humoral hypothesis suggests that a malarial toxin may be released that stimulates macrophages to release TNF-a and other cytokines such as IL-1. The cytokines themselves are not harmful, but they may induce additional and uncontrolled production of nitric oxide. Nitric oxide would diffuse through the blood-brain barrier and impose similar changes on synaptic function as do general anesthetics and high concentrations of ethanol, leading to a state of reduced consciousness. The biochemical nature of this interaction would explain the reversibility of coma.

What are possible treatment options?
As cerebral malaria is fatal within days of malaria infection if left untreated, immediate treatment is crucial. Because natural immunity to malaria is not fully understood and thus cannot yet be artificially imitated by drugs, control and prevention strategies are significant. Two of these are antimalarial chemotherapy and adjunctive measures. Public health interventions are also critical.

Chemotherapy for cerebral malaria now primarily involves the use of quinine, for a patient with severe CM must be assumed to have chloroquine resistance. It is one of the four main alkaloids found in the bark of the Cinchona tree and is the only drug which over a long period of time has remained largely effective for treating the disease.

The research revealed alot but I'll stop here. I'm sharing this because people need to know of this kind of illness and treat it as fast as possible. The doctor told me that a lot of people have died from this kind of malaria out of ignorance. They think it's regular malaria and take regular malaria drugs until it's too late.

So if you know or come across anyone with this kind of malaria, please tell them how risky it is not to go see a doctor asap. Let me say here that not all doctors can treat this kind of malaria, you need to go to a specialist hospital...this kind of malaria is rare but deadly. I've seen first hand what this illness can do to someone. She's lucky to be alive.

Please take care of your health.