Human cerebral malaria: 2019 mini review

During severe malaria, both in endemic and non-endemic areas, cerebral malaria is strongly associated with mortality and morbidity. The main mechanisms of cerebral malaria combine sequestration of parasitized red blood cells in brain capillaries, production of cytokines, immune cell/platelet accumulation, and release of microparticules, finally resulting in endothelial lesions of the blood brain barrier, which contribute to various brain injuries (oedema, ischemia, haemorrhages). The neurological clinical findings range from simple delirium to profound coma. Fundoscopy, reflect of the brain microcirculation, is now currently realized in endemic areas, and should be recommended during imported cerebral malaria. Likewise, cerebral imaging should be systematically realized in patients with cerebral malaria. Intravenous artesunate is now firmly established as the treatment of choice for severe malaria worldwide in adults, children and during pregnancy. General care and supportive treatment are crucially important and supportive treatment of cerebral malaria should be better standardized. Finally, experimental and clinical research has a key role in cerebral malaria, so as to identify possible therapeutic targets in order to develop innovative therapies.