1/6. Management of severe and complicated malaria in the intensive care unit.malaria remains today one of the major health problems in the tropics with increased morbidity and mortality. The most serious complications are caused by plasmodium falciparum, which, in contrast to the benign malarias, may progress to a life-threatening multi-system disease. Our case concerns a young woman in the 14th week of pregnancy, admitted to the ICU in a coma, with pulmonary oedema, haemolytic anaemia, renal failure and thrombocytopenia as complications of P. falciparum malaria. The case is discussed and possible explanations for the clinical picture and complications of P. falciparum malaria are given in the light of experiences from the literature.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/6. Inducible nitric oxide synthase expression is increased in the brain in fatal cerebral malaria.AIMS: Nitric oxide (NO) has been hypothesized to play a major role in the pathogenesis of cerebral malaria caused by P. falciparum infection. NO may act as a local neuroactive mediator contributing to the coma of cerebral malaria (CM). We hypothesized that increased expression of inducible nitric oxide synthase (iNOS) may cause increased release of NO, and examined the expression and distribution of iNOS in the brain during CM. MATERIAL AND RESULTS: brain tissues from fatal cases of cerebral malaria in Thai adults were examined using immunohistochemical staining to detect iNOS. The distribution and strength of staining was compared between 14 patients with CM, three of whom were recovering from coma, and controls. iNOS expression was found in endothelial cells, neurones, astrocytes and microglial cells in CM cases. There was also strong staining in macrophages surrounding ring haemorrhages. iNOS staining was decreased in recovering malaria cases compared to acute CM, and was low in controls. Quantification showed a significant association between the intensity and number of iNOS positive vessels with the severity of malaria related histopathological changes, although the total number of cells staining was not increased compared to recovering CM cases. CONCLUSIONS: This study indicates that an acute induction of iNOS expression occurs in the brain during CM. This occurs in a number of different cells types, and is increased in the acute phase of CM compared to cases recovering from coma. As NO may activate a number of secondary neuropathological mechanisms in the brain, including modulators of synaptic function, induction of iNOS expression in cerebral malaria may contribute to coma, seizures and death.- - - - - - - - - - ranking = 4keywords = coma (Clic here for more details about this article) |
3/6. Peripheral gangrene in nonfatal pediatric cerebral malaria: a report of two cases.Two Thai girls aged 10 and 13 years from the same rural area were admitted to Paholpolpayuhasena Hospital, Kanchanaburi, thailand during the rainy season of 1989 with cerebral malaria. After several days of conventional treatment, both developed gangrene involving the feet and toes, but the lesions healed and no other complications were seen. In the absence of convincing clinical and laboratory evidence of vasculitis or coagulopathy, it seems likely that host factors (dehydration, sluggish peripheral circulation, platelet activation, subclinical intravascular coagulation) combined with strain-specific parasite factors (tissue sequestration of mature forms, rosette formation) may predispose to peripheral microvascular occlusion sufficient to produce infarction of tissue in susceptible children. However, despite the apparently ominous appearance of such lesions in a comatose child, the prognosis seems good.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
4/6. A correlation between sequestered parasitized erythrocytes in subcutaneous tissue and cerebral malaria.Sequestered parasitized erythrocytes were found in microvessels of subcutaneous tissues in a comatose patient with cerebral malaria even though the blood smears were negative after quinine treatment. This situation reflects the continued presence of sequestered parasites in the brain and suggests that negative parasitemia in peripheral blood does not necessarily mean the end point of malarial treatment has been reached. Our findings suggest that biopsy of subcutaneous tissue from severe malaria patients may be useful for determining the severity and prognosis of malaria patients.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
5/6. Psychosis after cerebral malaria in children.A self-limiting psychosis characterized by visual and auditory hallucinations with or without aggressive behavior developed in two children 4 to 5 days after complete recovery from a cerebral malaria coma. Both patients had no family history of psychosis and were neurologically and mentally normal before the acute disease. A long-term prospective study to define the precise clinical spectrum of such manifestations in survivors of childhood cerebral malaria seems necessary.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/6. Ocular malaria. A clinical and histopathologic study.PURPOSE: Clinical and histopathologic findings of ocular lesions in malaria rarely have been described. This study reports lesions in three patients with malaria, with a histopathologic study of eyes obtained at autopsy of one of these patients. methods: Various ocular lesions were documented in three patients with malarial infection, with histopathologic study of one patient. In all three patients, the diagnosis of malaria was confirmed by the demonstration of malarial parasites in peripheral smears and by fluorescent microscopy of acridine orange-stained buffy coat preparations of venous blood. RESULTS: Multiple superficial blotchy retinal hemorrhages over the posterior pole were seen in the first patient, whereas acute bilateral panuveitis and secondary glaucoma were seen in the second, which on resolution showed multiple blotchy superficial retinal hemorrhages with perivasculitis. The third patient had cerebral malaria and was found to have subconjunctival and retinal hemorrhages. This patient died of pulmonary thromboembolism, and the eyes were obtained at autopsy. On gross examination, there were multiple retinal hemorrhages in the posterior pole. Histopathologic study showed cytoadherence of parasitized erythrocytes as well as schizonts and gametocytes of plasmodium vivax within the retinal and choroidal blood vessels. CONCLUSION: The authors' findings suggest that patients with unexplained blotchy retinal hemorrhages should be investigated for malarial infection, especially if they reside or have travelled in endemic areas.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |