Question

A white Latin American Professor visits Ghana with a Colleague of African descent (Usman), who was born in Ghana and has both parents living in Ghana, but he is working on a Project with his White Colleague in North of Canada. The white Professor consulted a Tropical Medicine expert and started antimalarial prophylaxis before his visit to Ghana but his African friend had some misconceptions about the efficacy and side effects of the medicines for prophylaxis so he declined its use before travel and while he was in Ghana. Usman developed serious malaria illness whilst in Ghana and almost died, but for prompt action from his Ghanaian relatives and Medical experts in an intensive care unit of the referral hospital he was rushed to. 3. Assuming Usman suffered seizures, was hemiplegic and went into coma as part of the complications observed whilst on transition to the hospital, or in the hospital, what terminology you would use to describe this type of complication from severe malaria illness 1 Mark. Give reason(s) for your answer- 3 marks

4. List other symptoms or signs complications to Severe and Complicated malaria and indicate how it should be managed therapeutically or non-therapeutically, backed by current evidence of safety & efficacy -10 marks

Answer 1

1) ans)Cerebral Malaria is a symmetric and diffuse, potentially reversible encephalopathy caused mainly by P. falciparum.It is an error to considering that any cerebral clinical manifestation in a patient with malaria is defining the disease.The most agreed definition includes the confirmation of P. falciparum infection and the exclusion of other causes of encephalitis,since neurological symptoms can be mimicked by metabolic acidosis, anemia or hypoglycemia

If parasite-filled blood cells block small blood vessels to your brain (cerebral malaria), swelling of your brain or brain damage may occur. Cerebral malaria may cause seizures and coma. Breathing problems. Accumulated fluid in your lungs (pulmonary edema) can make it difficult to breathe

Cerebral malaria

In rare cases, malaria can affect the brain. This is known as cerebral malaria, which can cause your brain to swell, sometimes leading to permanent brain damage. It can also cause fits (seizures) or coma.

When patients are suffering from the most severe form of malaria, known as cerebral malaria, infected red blood cells are trapped within the microscopic vessels of the brain. This impedes critical oxygen delivery, resulting in coma and often leading to death
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2) Ans)Severe malaria is defined as presence of Plasmodium falciparum parasitemia and one or more of the manifestations in the table (table 1). Most cases of severe malaria are attributable to Plasmodium falciparum (90 percent), but Plasmodium vivax and Plasmodium knowlesi can also cause severe disease

Other complications of a severe case of malaria can include:

breathing problems (such as fluid in your lungs)

liver failure and jaundice (a yellow discolouration of the skin)

shock (sudden drop in blood flow)

spontaneous bleeding.

abnormally low blood sugar.

kidney failure.

swelling and rupturing of the spleen.

dehydration

In adults, cerebral malaria is part of a multi-organ disease. Patients develop fever, headache, body ache and progressively, delirium and coma. Compared to African children, seizures papilledema and retinal changes are less common and coma resolution is slower

Treat adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women) with intravenous or intramuscular artesunate for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oral therapy, complete treatment with 3 days of an ACT.

Strong recommendation, high-quality evidence

Researchers are working to create a vaccine against malaria. Vaccination is expected to become an important tool to prevent malaria in the future.

One way to prevent malaria is to avoid mosquito bites with the following strategies:

As much as possible, stay indoors in well-screened areas, especially at night when mosquitoes are most active.  

Use mosquito nets and bed nets. It's best to treat the nets with the insect repellant permethrin.  

Wear clothing that covers most of your body.  

Use an insect repellent that contains DEET or picaridin. These repellents are applied directly to your skin, except around your mouth and eyes. If you choose a picaridin-based repellant, you will need to reapply it every several hours.  

Apply permethrin to clothing.  

It is strongly recommended that you take preventive medication when you travel to a region of the world that has malaria. Keep in mind that these medications can prevent most malaria infections, but travelers occasionally get malaria even when they are taking one of these drugs. If you develop an illness with fever within a year of your return, seek immediate medical attention and tell a health care professional about your travel.  

Efficacy:
Treatment regimen differed depending on the study but consisted essentially in IV AS (except for the use of rectal route in one study),n first or second line (mostly after IV Quinine) alone or in association with several anti-malarial drugs. In a vast majority of cases, patients were treated for severe malaria
Preventing long-term sequelae, such as improving neurocognitive outcomes in SM survivors, should be an important consideration when it comes to potential adjunctive therapy; however so far, the majority of attempts to enhance the efficacy of anti-malarial drugs with adjunctive therapy have failed. The development of adjunctive therapy would benefit from a more complete understanding of the physiopathology of SM and CM, and how it differs between adults and children. The identification of host biomarkers associated with disease severity and host response to treatment could provide a useful read out of therapeutic efficacy, and empower RCTs to evaluate adjunctive therapy with smaller and better defined cohorts.

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