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Dr. Gadadhar Sarangi Cuttack, Orissa

CEREBRAL MALARIA. Dr. Gadadhar Sarangi Cuttack, Orissa. Malaria Threatens 40% world population. From Near Extinsion in 1976 India contributes 85% of cases in South East Asia 1 st clinical description – Hippocrates Elaborated – Celsus Peruvian Bark in therapy – 17 th Century

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Dr. Gadadhar Sarangi Cuttack, Orissa

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  1. CEREBRAL MALARIA Dr. Gadadhar SarangiCuttack, Orissa

  2. Malaria Threatens 40% world population

  3. From Near Extinsion in 1976 India contributes 85% of cases in South East Asia 1st clinical description – Hippocrates Elaborated – Celsus Peruvian Bark in therapy – 17th Century Quinine – 1820 Man to Mosquito Cycle – Sir Ronald Ross – 1998-99

  4. Definition • Complication of plasmodium falciparum • Unarousable coma more than 30 mts • Exclusion of other causes

  5. Aetio Pathogenesis • Sequestration of Cerebral Capillaries and Venules • Ring like lesions in the Brain

  6. Mechanical Hypothesis P. falciparum parasites in brain capillary

  7. Section of brain showing blood vessels blocked with developing P. falciparum parasites

  8. Selective Cytoadherance results in rosetting • Reduction of Microvascular Blood flow • Hypoxia • Dose not explain selective absence of Neurological Deficits

  9. Humoral Hypothesis • Malaria Toxin • Stimulates Production of TNF- alpha & Cytokines • Stimulate Endothelial cells • Uncontrolled production of NO • COMA

  10. c

  11. CLINICAL MANIFASTATIONS • The seasonal Trend

  12. Earliest Manifestations - • Fever • Loss of Appetite • Vomiting • Cough • Specific for Cerebral Malaria • Impaired consiousness • Gen. Convulsion with Sequelae • Coma

  13. Coma Scale for Children Best Motor response Localizes painful stimulus 2 Withdraws limb from pain 1 Non-specific or Absent response 0 Verbal Response Appropriate Cry 2 Moan or Inappropriate cry 1 None 0 Eye Movements Directed 1 (e.g. follows mother’s face) Not directed 0 Total 0-5

  14. Associated Presentation • Hypoglycaemia • Metabolic Acidosis • Shock • Neurological deficits • Other forms can Co-exist

  15. LABORATORY DIAGNOSIS

  16. Diagnosis of Falciparum Malaria • Conventional Microscopy • Giemsa Stain • Field Stain

  17. Stages of P. falciparum

  18. LABORATORY DIAGNOSISContd…. • Fluorescence Microscopy (QBC) • Nucleic Acid Staining with acridine • Parasite Count = (TLC / Cuml X Parasite / 100 WBC) / 100 = Parasite / Cuml of Blood • Serology • Anti body detection • Antigen detection (HRP) • Biochemical Test - Optimal test (Parasite LDH) • PCR & Culture

  19. CEREBRAL INVOLVEMENT • Clinical • CSF - Increased Lactic Acid • CT, MRI

  20. THOUGHTS AT BEDSIDE • Haemoglobin • Urobilinogen

  21. THERAPEUTIC OPTIONS • CHEMOTHERAPY • Quinine • Artemisinins - Artesunate • - Arte- ether • - Arte - mether

  22. SUPPORITIVE & ADJUNCTIVE THERAPY • Nursing Care • Catherization • Nasogastric tube • Fluid & Electrolyte • Monitor level of coma & vital signs • Antipyretics • Anticonvulsants • Reduction in ICT • Correction of Hypoglycaemia • Exchange Transfusion • IncreaseMicrocirculatory Flow - Pentoxyfylline • Desferrioxamine • Correction of - Anaemia, Acidosis, Dehydration

  23. NEWER HORIZON • Inhibition of Endothelial Activity • - LMP 420 - Decrease of TNF alpha & LT activity • Vaccine Development

  24. The End

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