Malaria is a life-threatening blood-borne infection. It is caused by a parasite belonging to the Plasmodium genus. 5 types of Plasmodium parasites infect humans and occurs all over the world. Symptoms of malaria vary from an uncomplicated one to severe malaria. In uncomplicated malaria, symptoms progress through cold & hot temperatures, fever, aches, and general fatigue. Severe malaria on the other hand poses with symptoms such as fever and chills, impaired unconsciousness, convulsions, respiratory stress, signs of anemia, and evidence of vital dysfunction.
Cerebral malaria is a severe type of malaria that affects blood vessels in the brain. It is an offshoot of malaria, and also the most severe neurological complication of infection with Plasmodium falciparum. According to statistics, there are over 575,000 cases of cerebral malaria in children every year, with 15-20% mortality. And of these figures, sub-Saharan Africa is the most affected. Surviving patients have an increased risk of neurological and cognitive deficits, behavioral difficulties, and epilepsy making cerebral malaria a leading cause of childhood Neuro-disability in the region.
Plasmodium falciparum is an insidious, microscopic parasite that live within mosquitoes. The anopheles mosquito is a carrier of this parasite, and malaria occurs when a there is a bite from the infected mosquito. In the case of cerebral malaria, the plasmodium parasite multiplies so much that it gets to the brain which in turn affects blood vessels in the brain. Sadly, children younger than 5 years are the most affected because their immune system have not fully developed a combative mechanism of fighting the infection.
The clinical hallmark of cerebral malaria is coma. In African children, coma develops suddenly with seizure onset often after 1–3 days of fever. A few children develop coma after progressive weakness and prostration. In adults, cerebral malaria is part of a multiorgan disease. Patients develop fever, headache, body ache, and, progressively, delirium and coma.
Without treatment, cerebral malaria is invariably fatal. In children, parenteral antimalarials (parenteral artesunate or artemisinin derivatives) are indicated, but even with this treatment, 15–20% die. However, in adults, mortality was lower if patients were treated with intravenous artesunate. In children, the major cause of death in cerebral malaria occurs when the brain becomes so swollen that it is forced out of the skull there causing a respiratory rest- the child stops breathing.
Although the pathology behind the brain injury has not been fully understood, the best way to prevent cerebral malaria in children is to have effective preventive and control measures for malaria infection. Although we are still at risk from malaria even with the use of protection. Therefore to avoid mosquito bites the following are recommended:
- Apply insect repellant to exposed skin
- Wear long sleeved clothing and long pants if you are going to be staying out late
- Use an insecticide-treated bed nets
Further preventive and control measures include:
- Ensuring a very clean environment, without breeding of stagnant water
- Prompt and accurate diagnosis of illness
- Appropriate use of effective antimalarial drugs.