Imported cerebral malaria complicated with glucose 6 phosphate dehydrogenase deficiency

Two cases of cerebral malaria imported from Guyana and Ghana are reported. These are the first cases of cerebral malaria diagnosed and treated in Trinidad and Tobago since malaria was eradicated. The management of both these cases was complicated because the patients' erythrocytes were glucose-6-phosphate dehydrogenase-deficient, and by the occurrence of blackwater fever, cerebral manifestations, renal impairment, hyperglycaemia and thrombocytopenia. The symptoms of cerebral malaria resolved following treatment with quinidine and doxycycline and quinidine and clindamycin.

A case of vivax malaria presenting with psyhosis

The first case of psychosis due to Plasmodium vivax malaria, imported from India is reported. A 44-year-old Trinidadian male presented with fever, and psychotic episodes in association with vivax malaria. The symptoms of both malaria and psychosis were resolved following the standard chloroquine-primaquine therapy

Falciparum malaria treated with a chloroquine suspension administered rectally in Trinidad

A new mode of administering malaria chemotherapy to patients unable to tolerate oral medication is described. A patient with Plasmodium falciparum malaria, severe hyponatraemia and hypokalaemia who regurgitated oral treatment of chloroquine phosphate and pyrimethamine and sulfadoxine (Fansidar) is presented. But neither chloroquine nor quinine intravenous formulations were available locally. As the patient was deteriorating, a suspension of chloroquine phosphate was prepared and administered rectally, resulting in a decline in the level of parasitaemia from ++++ to ++ within 48 hours. The patient improved, and further clinical management was uncomplicated.