Non-cerebral malaria: does such a thing exist?

Area of Science:

• Infectious Diseases
• Neuroscience
• Public Health

Background:

• Malaria, caused by Plasmodium parasites, is a significant global health concern.
• Cerebral malaria, a severe form, has high mortality and neurocognitive sequelae in survivors.
• Emerging evidence suggests impairments occur even in non-cerebral and asymptomatic malaria.

Purpose of the Study:

• To review the expanding evidence of neurocognitive and behavioral impairments associated with malaria.
• To challenge the current definition of cerebral malaria and propose a broader conceptualization.
• To highlight the potential impact of non-severe malaria on global neurological morbidity.

Main Methods:

• Review of recent studies on neurocognitive and behavioral outcomes in malaria patients.
• Analysis of neuroimaging findings in severe and non-severe malaria.
• Comparison of observed sequelae with the current World Health Organization (WHO) definition of cerebral malaria.

Main Results:

• Neurocognitive and behavioral impairments are reported in severe non-cerebral malaria, non-severe malaria, and asymptomatic Plasmodium infections.
• Mild vasogenic edema observed in neuroimaging of non-cerebral malaria cases.
• Significant proportion of global malaria morbidity may stem from sequelae of non-severe malaria.

Conclusions:

• Systemic inflammation from malaria, irrespective of cerebral involvement, can impair brain function and cause long-term sequelae.
• The current definition of cerebral malaria is insufficient to capture the full spectrum of malaria-associated neurological damage.
• A revised conceptual framework is needed to address the widespread neurocognitive and behavioral impacts of malaria.