Definition Complication of plasmodium falciparum



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tarix14.01.2017
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  • 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



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



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





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