Changing trends in malaria--a decade's experience at a referral hospital.

A 10 year study of malaria during 1989-98 recorded an increase in the incidence of malaria from 0.22 in 1989 to 1.3 in 1996 following which it has reached a plateau. The cases were chiefly from Karnataka, Andhra Pradesh and Tamil nadu. The P. falciparum infection and mixed infections (P. falciparum and vivax) were found to be on the rise. Peak of malaria cases were recorded in the months of June-July and in Oct-Nov coinciding with the rains showing a seasonal pattern. The common haematological findings were anemia, thrombocytopenia, pancytopenia and leucopenia. Complications noted in our study were haemolysis, renal failure, hepatopathy and cerebral malaria. The unusual cases were congenital malaria, malaria with sickle cell anemia, AIHA and G-6PD deficiency. Mortality due to cerebral malaria was found to be 13.5%.

Severe falciparum malarial complications in Ukhrul, Manipur.

Development of complications is very common among the patients suffering from Plasmodium falciparum infection. A total of 64 patients of Plasmodium falciprum infections were admitted to the District Hospital, Ukhrul, during the period of 1st May 1996 to 15th June 1999; 9.37% patients do not develop complication while the rest 90.63% developed one or more complications. The most common complication is anaemia accounting for 76.56% followed by cerebral malaria (59.38%). Other lesser complications were leucopenia (15.63%), thrombocytopenia (26.56%), adult respiratory distress syndrome (6.25%). There is no single record of blackwater fever, 12.5% died due to development of multiple complications like severe haemolytic anaemia, haemolytic jaundice, cerebral malaria and acute renal failure. This study confirms presence of severe and complicated falciparum malaria in this part of the country.

Resurgence of malaria in Calcutta in 1995: a hospital based study.

A total of 405 cases of fever who were either admitted to the Hospital or attended in paediatric out patient Department or Emergency of Medical College Hospital, Calcutta between January '95 and November '95 were included in the study. Majority of cases presented with usual features of malaria like fever with chill and rigor, hepatosplenomegaly, pallor. Apart from these, complicated manifestations like shock, convulsion D.I.C and jaundice were also observed. Some unusual presentations with severe diarrhoea, dehydration and features like that of acute viral respiratory tract infection were highly confusing in terms of clinical diagnosis. P. falciparum was observed in 35.5% of cases. Overall therapeutic response to chloroquin was good, However, two patients died of cerebral Malaria. Five cases of severe malaria were caused by P. vivax however, other etiological features could not be found to attribute the severe nature of these illnesses.

Epidemiology of cerbral malaria and its mortality

Over the past 5 years, 1620 comatosed patients of both sexes aged 1-75 years were screened for cerebral malaria. Of these, 505 [31.2%] were positive for Plasmodium falciparum. During this period frequency of malaria increased from 22.1% in 1991 to 44.4% in 1995. Sixty-four% cases of cerebral malaria were seen in children and thirty-six% in adults. Mortality was also higher [41%] in children than in adults [25%]. As cerebral malaria is particularly prevalent in Pakistan and is a major community problem, accurate and easier methods of its diagnosis are needed at primary health care level, in all febrile comatose patients, without focal neurological findings

Complicated falciparum malaria.

We studied 50 cases of complicated falciparum malaria in order to evaluate the different clinical presentations. Thirty five had cerebral malaria while 15 presented with extracerebral features including diarrhea and vomiting (n = 6), hepatitis (n = 4), acute renal failure (n = 3), and gastrointestinal bleeding (n = 2). These cases were treated with quinine. Mortality was higher in extracerebral form (33.3%) as compared to cerebral malaria (22%). Our study suggests that even though cerebral malaria remains the single most important cause of high mortality in complicated falciparum malaria, extracerebral presentation of falciparum malaria is equally life threatening and should be viewed seriously.

Malaria and the nervous system

El paludismo cerebral se define como encefalopatía aguda que complica exclusivamente a la infección por pasmodium falcíparum y que afecta principalmente a niños y adolescentes en áreas hiperendémicas. La fisiopatología de esta entidad se explica por el taponamiento de los capilares y vénulas cerebrales por paquetes de glóbulos rojos parasitados o por una respuesta inflamatoria no específica, mediada inmunologicamente, con liberación de sustancias vasoactivas capaces de producir daño endotelial y alteración en la permeabilidad capilar. El paludismo cerebral tiene una mortalidad del 50 por ciento, así como una morbilidad elevada, especialmente en niños. Por otra parte, el desarrollo de hipoglicemia, especialmente en pacientes tratados con quinina, puede complicar la sintomatología cerebral. Otras manifestaciones neurológicas del paludismo cerebral incluyen: hemorragia intracraneal, oclusión de arterias intracraneales y manifestaciones transitorias de tipo extrapiramidal o psiquiátrico. En Sro-Lanka se ha reconocido, además, una ataxia cerebelosa aislada y autolimitada, probablemente medida por mecanismos inmunológicos, en pacientes que se están recuperando de una infección por plasmodium falciparum. El paludismo es una causa relativamente común de crisis febriles en regiones tropicales y también contribuye al desarrollo de epilepsia en edades posteriores de la vida. Existen además, varios periféricos en pacientes con paludismo cerebral, así como la parálisis periódica. La fisiopatología de estas manifestaciones neurológicas no se encuentra bien determinada, pero ofrece excelentes oportunidades para investigación, tanto a nivel clínico como experimental.