Definition Complication of plasmodium falciparum

• Dr. Gadadhar Sarangi Cuttack, Orissa

Definition

• Complication of plasmodium falciparum

• Unarousable coma more than 30 mts

• Exclusion of other causes

Aetio Pathogenesis

• Sequestration of Cerebral Capillaries and Venules

Mechanical Hypothesis

Humoral Hypothesis

• Malaria Toxin

• Stimulates Production of TNF- alpha & Cytokines

• Stimulate Endothelial cells

• Uncontrolled production of NO

• COMA

CLINICAL MANIFASTATIONS

• The seasonal Trend

Earliest Manifestations -

• Earliest Manifestations -

• Fever
• Loss of Appetite
• Vomiting
• Cough

• Specific for Cerebral Malaria

• Impaired consiousness
• Gen. Convulsion with Sequelae
• Coma

Coma Scale for Children

• Best Motor response Localizes painful stimulus 2

• Withdraws limb from pain 1

• Non-specific or Absent

• response 0

• Verbal Response Appropriate Cry 2

• Moan or Inappropriate cry 1

• None 0

• Eye Movements Directed 1

• (e.g. follows mother’s face)

• Not directed 0

• Total 0-5

Associated Presentation

• Hypoglycaemia

• Metabolic Acidosis

• Shock

• Neurological deficits

• Other forms can Co-exist

LABORATORY DIAGNOSIS

Diagnosis of Falciparum Malaria

• Conventional Microscopy

• Giemsa Stain
• Field Stain

LABORATORY DIAGNOSIS Contd….

• Fluorescence Microscopy (QBC)

• Nucleic Acid Staining with acridine

• Parasite Count = (TLC / Cuml X Parasite / 100 WBC) / 100 = Parasite / Cuml of Blood

• Serology

• Anti body detection
• Antigen detection (HRP)

• Biochemical Test - Optimal test (Parasite LDH)

• PCR & Culture

CEREBRAL INVOLVEMENT

• Clinical

• CSF - Increased Lactic Acid

• CT, MRI

THOUGHTS AT BEDSIDE

• Haemoglobin

• Urobilinogen

THERAPEUTIC OPTIONS

• CHEMOTHERAPY

• Quinine
• Artemisinins - Artesunate
• - Arte- ether
• - Arte - mether

SUPPORITIVE & ADJUNCTIVE THERAPY

• Nursing Care

• Catherization

• Nasogastric tube

• Fluid & Electrolyte

• Monitor level of coma & vital signs

• Antipyretics

• Anticonvulsants

• Reduction in ICT

• Correction of Hypoglycaemia

• Exchange Transfusion

• IncreaseMicrocirculatory Flow - Pentoxyfylline

• Desferrioxamine

• Correction of - Anaemia, Acidosis, Dehydration

NEWER HORIZON

• Inhibition of Endothelial Activity

• - LMP 420 - Decrease of TNF alpha & LT activity

• Vaccine Development