Cerebral malaria: When untreated malaria sends patients into coma

Cerebral malaria is a severe neurological complication caused by parasitic infection of a bite by an anopheles female mosquito.

According to Dr George Biketi, the disease presents with a clinical syndrome characterised by coma and asexual forms of the parasite on peripheral blood smears.

“Patients with malaria-related symptoms are advised to undergo treatment and screening, to prevent them from developing cerebral malaria, which is more lethal,” he says.

He adds that cerebral malaria involves the central nervous system, affecting the flow of oxygen and glucose in the body which results in fatalities and more complicated health problems.

“Cerebral malaria is a kind of malaria that develops between 72 hours and seven days, of failing to seek treatment,” he explains, “common symptoms presented by patients are fever, headache, general joint pains, and as the disease progresses if untreated, it crosses to the central nervous system (brain).”

It is at such a stage that a patient has confusion, comatose, and convulsion with others presenting with features of psychosis.

According to the general physician, cerebral malaria derives oxygen and glucose, resulting in risks of having a patient go into a coma.

“At advanced stages, patients risk death,” Dr Biketi says. “The elderly, children below the age of five years and pregnant women are the most affected with the disease due to their low immunity.”

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He added that diagnosis of the disease involves carrying out blood tests, retinopathy (eye) and spinal fluids from the spinal cord.

“Standard treatment of cerebral malaria by Ministry of Health is Artemimcinin Combination Therapy (ACT), which is given in six doses, and later placed on oral medication,” Dr Biketi says.

He adds that in some severe cases, patients also use quinine, given in seven doses.

“Patients with cerebral malaria recover if put on treatment, but some will develop other complications, as the disease affects other organs of the body, like the brain,” he says.

According to the US National Library of Medicine and National Institute of Health, cerebral malaria is the most severe neurological complication of infection with Plasmodium falciparum, with over 575,000 cases annually. Children are the most affected in Sub-Saharan Africa.

Though patients with cerebral malaria are treated, the medical journal notes that they have high risks of neurological and cognitive deficits, behavioural difficulties and epilepsy.

In Kenya, out of 100 cases of malaria, at least 2 people test positive for cerebral malaria. Cerebral malaria is the most severe neurological manifestation of severe malaria, with an incidence of 1,120, out of 100,000 cases a year in endemic areas of Africa, according to CDC.