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Cerebral malaria: optimising management
Neema Mturi1, Crispin O Musumba, Betty M Wamola
1Kenya Medical Research Institute Centre for Geographic Medicine Research, Coast, Kilifi, Kenya.
Insights
Cerebral malaria, a severe brain complication, affects children and adults globally. Effective treatment relies on parenteral antimalarials like quinine, quinidine, and artemisinins, with supportive care crucial for better outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Global Health
Background:
- Cerebral malaria is a leading cause of nontraumatic encephalopathy worldwide, disproportionately affecting children in sub-Saharan Africa but increasingly seen in adults globally.
- Significant differences exist in clinical presentation and pathophysiology between African children and nonimmune adults.
- The condition carries a high mortality rate of 10-20%.
Purpose of the Study:
- To review the current understanding of cerebral malaria, focusing on pathophysiology, clinical presentation, and treatment strategies.
- To evaluate the efficacy of existing and potential therapeutic interventions, including antimalarials and ancillary treatments.
- To identify gaps in knowledge and areas requiring further research for improved patient outcomes.
Main Methods:
- Review of existing literature on cerebral malaria, including clinical studies and pathophysiological research.
- Analysis of treatment outcomes associated with parenteral antimalarials (cinchona alkaloids, artemisinins) and adjunctive therapies.
- Evaluation of evidence supporting or refuting the use of specific ancillary treatments like corticosteroids and deferoxamine.
Main Results:
- Parenteral antimalarials are the only interventions proven to impact cerebral malaria outcomes.
- Quinine and quinidine remain mainstays, with artemisinin derivatives gaining prominence.
- Aggressive seizure management is vital, especially in children. Ancillary treatments show potential but lack rigorous trial support.
Conclusions:
- Parenteral antimalarials are essential for treating cerebral malaria.
- Further research is needed for ancillary treatments that target pathophysiological mechanisms to prevent neurological sequelae and mortality.
- Corticosteroids and deferoxamine have limited evidence supporting their use in cerebral malaria.
Abstract:
Cerebral malaria is one of the most common nontraumatic encephalopathies in the world. Children living in sub-Saharan Africa bear the brunt of the disease, but cerebral malaria is being seen increasingly in adults throughout the world, including outside malarious areas. There are differences in the clinical presentation and pathophysiology between African children and nonimmune adults from any region. Mortality is high (10-20%). Parenteral antimalarials are the only interventions that have been shown to affect outcome. The cinchona alkaloids (quinine and quinidine) are the mainstay of antimalarial treatment, but the artemisinin derivatives are increasingly being used. Aggressive treatment and prevention of convulsions may be important, particularly in children. Other ancillary treatments that can be used to augment standard antimalarial drugs, such as exchange blood transfusions, osmotic diuretics and pentoxifylline, may improve outcome but have not been subjected to rigorous clinical trials. There is little support for corticosteroids or deferoxamine (desferrioxamine) in cerebral malaria. Other adjuncts have not been adequately tested. Further research is required on drugs that interfere with the pathophysiological processes to prevent neurological complications and death.
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