MALARIA

Five Plasmodium species cause human disease:

• Plasmodium falciparum
• Plasmodium vivax
• Plasmodium ovale
• Plasmodium malariae
• Plasmodium knowlesi

The majority of infections are caused by P falciparum and P vivax, and P

falciparum is responsible for the most severe disease.

There are few known animal reservoirs; examples include the chimpanzee for
P malariae and the crab-eating macaque (Macaca fascicularis) for P knowlesi
Adults who live in endemic areas may develop only minimal symptoms, due
to immunoglobulin G antibody and cell-mediated immunity, and to
physiological tolerance of parasitaemia.

However, individuals without pre-existing immunity, pregnant women,

children, older adults, and those with comorbidities (e.g., HIV infection) are
more at risk of severe malaria with Plasmodium falciparum.

Pregnant women are also at risk of miscarriage, anaemia, and

hyperparasitaemia.

Complications of severe malaria include cerebral involvement, which may

present as reduced consciousness level, diffuse disturbance of cerebral
function, or seizures.

Other complications include metabolic acidosis leading to respiratory

distress, renal impairment, jaundice, severe anaemia, hypoglycaemia,
disseminated intravascular coagulation, and shock.
 Cerebral malaria
Cerebral malaria is the most severe neurological complication of infection
with Plasmodium falciparum malaria. It is a clinical syndrome characterized
by coma and asexual forms of the parasite on peripheral blood smears.
Mortality is high and some surviving patients sustain brain injury which
manifest as long-term neuro-cognitive impairments.

The World Health Organization defines cerebral malaria as a clinical

syndrome characterized by coma at least 1 hour after termination of a
seizure or correction of hypoglycemia, asexual forms of Plasmodium
falciparum parasites on peripheral blood smears and no other cause to
explain the coma.
Other systemic complications such as anemia, metabolic acidosis, electrolyte
imbalance and hyperpyrexia or hypoglycemia and shock are commonly
present. The prognosis is grave in deeply comatose patients with severe
metabolic acidosis, shock, hypoglycemia and repeated seizures.
Sequelae of cerebral malaria
Diagnosis
Treatment
Treatment
Treatment