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Plasmodium vivax malaria presenting with severe thrombocytopenia, cerebral complications and hydrocephalus

Rekha Harish1, Sanjeev Gupta

  • 1Department of Pediatrics, Government Medical College, Jammu, India.

Indian Journal of Pediatrics
|April 25, 2009
PubMed

Insights

Plasmodium vivax malaria can cause severe central nervous system (CNS) complications in children, including encephalopathy and seizures. While quinine treatment was effective, both pediatric cases reported here experienced lasting neurological deficits.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Tropical Medicine

Background:

  • Plasmodium vivax malaria is a significant global health concern, particularly in tropical and subtropical regions.
  • Central nervous system (CNS) involvement in malaria, while more commonly associated with Plasmodium falciparum, can occur with other Plasmodium species.
  • Understanding the spectrum of CNS complications in pediatric malaria is crucial for timely diagnosis and management.

Observation:

  • Two pediatric cases (ages 1 and 4 years) of Plasmodium vivax malaria with severe CNS complications are presented.
  • Both children exhibited encephalopathy and seizures as primary neurological manifestations.
  • Case 1 presented with severe thrombocytopenia, massive intracranial hemorrhage, and hydrocephalus necessitating shunt surgery.

Findings:

  • The second child experienced gastrointestinal symptoms alongside encephalopathy and hydrocephalus.
  • Both patients demonstrated a clinical response to quinine therapy.
  • Despite treatment, both children were left with significant neurological sequelae.

Implications:

  • This report highlights the potential for severe CNS complications, including intracranial bleeding and hydrocephalus, in pediatric Plasmodium vivax malaria.
  • Early recognition and prompt treatment with antimalarials like quinine are essential, even in cases of P. vivax.
  • The occurrence of long-term neurological deficits underscores the importance of vigilant follow-up and supportive care for children with complicated malaria.

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