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Cerebral malaria at San Lazaro Hospital, Manila, Philippines
Abstract:
Forty cases of cerebral Plasmodium falciparum malaria seen at San Lazaro Hospital, Manila, Philippines from 1979-1981 were reviewed. These cases represented 7% of all Plasmodium falciparum cases seen during this period. All of the patients had fever and headache, 73% confusion, 70% chills, 68% jaundice or abdominal pain, 60% sweats. Findings more frequent in the fatal compared to the non-fatal cases were: the presence of schizonts in the peripheral smear, oliguria, coma, convulsions, urinary incontinence, jaundice, pulmonary symptoms and vomiting. Fatal cases were less likely to be clinically diagnosed as malaria and more likely to be diagnosed as hepatitis than malaria. The treatment and management of these cases is discussed.
Insights
Cerebral malaria caused by Plasmodium falciparum is a severe complication, often misdiagnosed. Fatal cases showed specific symptoms like coma and jaundice, highlighting the need for accurate diagnosis and management.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Neurology
Background:
- Cerebral malaria, a severe Plasmodium falciparum complication, presents diagnostic challenges.
- Understanding clinical features is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To review clinical features and outcomes of cerebral malaria cases.
- To identify factors associated with fatal outcomes in cerebral malaria.
Main Methods:
- Retrospective review of 40 cerebral Plasmodium falciparum malaria cases.
- Analysis of clinical presentation, laboratory findings, and patient outcomes.
Main Results:
- Fever and headache were common; confusion, chills, jaundice, and abdominal pain were also frequent.
- Fatal cases were characterized by schizonts in peripheral smears, oliguria, coma, convulsions, jaundice, and pulmonary symptoms.
- Fatal cases were more frequently misdiagnosed as hepatitis than malaria.
Conclusions:
- Cerebral malaria requires high clinical suspicion, especially with characteristic symptoms.
- Accurate diagnosis and prompt management are critical to reduce mortality.
- Misdiagnosis, particularly as hepatitis, can delay appropriate malaria treatment.