Cerebral malaria [letter]

When young children are infected with P. falciparum; meningitis is often incidentally associated with parasitaemia and can be difficult to distinguish clinically from cerebral malaria. There is yet no clear evidence that lumbar puncture is dangerous in cerebral malaria and it is reasonable to do lumbar punctures to exclude bacterial meningitis in children with fever and coma in areas where malaria is endemic

Efficacy of quinine for falciparum malaria according to previous chloroquine exposure. [short report]

Chloroquine has been reported to antagonize the anti-parasitic action of quinine against Plasmodium falciparum in vitro. The authors looked for evidence of any such antagonism in vivo. In 123 Malawian children with cerebral malaria treated with parenteral quinine; the likelihood of survival and the rate of recovery were much the same in patients who had taken chloroquine and those who had not. In these circumstances there was no evidence of chloroquine/quinine antagonism

Cerebral malaria in children II: causes and treatment of hypoglycaemia before and during treatment

Presenting hypoglycaemia must be looked for in all patients with cerebral malaria; since it carries a poor prognosis and can be corrected. Several possible mechanisms for its development are discussed. It is important to continue to consider hypoglycaemia during treatment; since it may recur. Regular glucose supplementation must be given during quinine treatment; to prevent starvation hypoglycaemia. Quinine-induced hypoglycaemia does not seem to be a major problem in these circumstances; although the possibility must not be neglected; especially if treatment is prolonged

Cerebral malaria in children: I: presenting features and prognosis

A study of 96 children with altered consciousness and Plasmodium falciparum parasitaemia in the period January-June 1987 at Queen Elizabeth Central Hospital in Blantyre. It was observed that the most closely associated feature with a poor prognosis is hypoglycemia