Title: Dr. Gadadhar Sarangi Cuttack, Orissa
1CEREBRAL MALARIA
- Dr. Gadadhar SarangiCuttack, Orissa
2Malaria Threatens 40 world population
3From Near Extinsion in 1976 India contributes 85
of cases in South East Asia 1st clinical
description Hippocrates Elaborated
Celsus Peruvian Bark in therapy 17th
Century Quinine 1820 Man to Mosquito Cycle
Sir Ronald Ross 1998-99
4(No Transcript)
5Definition
- Complication of plasmodium falciparum
- Unarousable coma more than 30 mts
- Exclusion of other causes
6Aetio Pathogenesis
- Sequestration of Cerebral Capillaries and Venules
- Ring like lesions in the Brain
7Mechanical Hypothesis
P. falciparum parasites in brain capillary
8Section of brain showing blood vessels blocked
with developing P. falciparum parasites
9- Selective Cytoadherance results in rosetting
- Reduction of Microvascular Blood flow
- Hypoxia
- Dose not explain selective absence of
Neurological Deficits
10Humoral Hypothesis
- Malaria Toxin
- Stimulates Production of TNF- alpha Cytokines
- Stimulate Endothelial cells
- Uncontrolled production of NO
- COMA
11c
12CLINICAL MANIFASTATIONS
13- Earliest Manifestations -
- Fever
- Loss of Appetite
- Vomiting
- Cough
- Specific for Cerebral Malaria
- Impaired consiousness
- Gen. Convulsion with Sequelae
- Coma
14Coma 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 mothers face)
- Not directed 0
- Total 0-5
-
15Associated Presentation
- Hypoglycaemia
- Metabolic Acidosis
- Shock
- Neurological deficits
- Other forms can Co-exist
16LABORATORY DIAGNOSIS
17Diagnosis of Falciparum Malaria
- Conventional Microscopy
- Giemsa Stain
- Field Stain
18Stages of P. falciparum
19LABORATORY 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
20CEREBRAL INVOLVEMENT
- Clinical
- CSF - Increased Lactic Acid
- CT, MRI
21THOUGHTS AT BEDSIDE
22THERAPEUTIC OPTIONS
- CHEMOTHERAPY
- Quinine
- Artemisinins - Artesunate
- - Arte- ether
- - Arte - mether
23SUPPORITIVE 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
24NEWER HORIZON
- Inhibition of Endothelial Activity
- - LMP 420 - Decrease of TNF alpha LT activity
- Vaccine Development
25The End