By Dr. RACHNA PANDE
For some lay people, any pain in the body anywhere is malaria. This shows that people know that malaria is a common sickness. People generally associate malaria with fever, chills and body ache, but are not aware of the other different ways it can manifest.
Of all types of infections caused by malaria, the deadliest is cerebral malaria. It is caused by the species of the malaria parasite called plasmodium falciparum.
The parasite passing through its asexual phase of multiplication in the human body tends to parasitize the red blood corpuscles in the blood vessels. They multiply there and rupture the blood cells, releasing parasites in the blood stream. Through blood it can affect the brain.
The typical intermittent fever of malaria may not be always present in case of cerebral malaria. Sensation of chills may also not occur. There may be just sudden onset of high fever. Very high fever if present can be deleterious for brain, particularly in case of children. A person with cerebral malaria can become unconscious suddenly, go in to coma and die suddenly with no high fever before. Neurological complications like sudden paralysis of one or more limbs can occur. Compression and irritation of the brain substance can lead to convulsions which pose a risk for respiratory arrest.
Slight cough, flu like symptoms and or mild diarrhea and vomiting may also be present at the beginning.
Acute anemia can develop due to rupture of blood cells, necessitating blood transfusion at times.
The affected person may develop acute hypoglycemia (low blood glucose levels in the blood), which adds on to the unconsciousness. Acute renal failure and liver failure are yet another complications of cerebral malaria, which occur due to damage of blood vessels supplying these parts.
Sudden accumulation of fluid can occur in the lungs as complication of cerebral malaria which causes respiratory distress. Respiratory distress is further aggravated by metabolic acidosis. A bed ridden very sick person is also at risk of aspirating water drunk or his own saliva or expectoration as he is unable to bring it out. This results in aspiration pneumonia which also causes breathing difficulty and cyanosis.
All these complications are potentially fatal. But if diagnosed and treated promptly cerebral malaria is a curable condition and the person recovers fully.
Diagnosis is established as per WHO criteria of thick and thin blood films. This disease needs to be differentiated clinically and with due investigations from other infections causing coma and neurological complications like typhoid fever, meningitis and HIV encephalopathy. Treatment is by anti malarial drugs.
Chemoprophylaxis (using anti malarial drugs) for cerebral malaria is the same as for other forms of malaria. But over all prevention is much better than chemoprophylaxis. This includes using insecticide sprayed mosquito nets, insect repellants both for the house and local application on body to prevent mosquito bites. Keeping the surroundings clean is useful for prevention of all illnesses including malaria. Particularly open ditches and cess pools of water should not be allowed as they provide breeding ground for mosquitoes.
The efforts made by government of Rwanda are laudable for control of malaria. Already it is way ahead of other African countries in controlling this deadly disease. The only thing needed is for the people to be more aware and make full use of the prevention and treatment measures provided by the government.
Dr. Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital
Originally published in The New Times Rwanda
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