11/50. Isolated cerebellar edema and obstructive hydrocephalus in a child with cerebral malaria. An important complication of cerebral malaria is increased intracranial pressure which, when severe, is associated with high mortality or neurologic sequelae. We describe a 7-month-old child with cerebral malaria for whom cerebellar edema and obstructive hydrocephalus were initial radiologic findings. Despite significant hydrocephalus, the child had normal intracranial pressure during the course of the infection, and he recovered with minimal sequelae. ( info) |
12/50. Cerebral involvement in benign tertian malaria. Although plasmodium vivax usually causes benign uncomplicated malaria, it can occasionally result in severe disease with life-threatening, end-organ involvement generally seen with falciparum malaria. We report a case of cerebral malaria caused by P. vivax and review the literature on this subject. ( info) |
13/50. Case report: severe acute symptomatic hyponatraemia in falciparum malaria. Hyponatraemia is a common finding in malaria, but rarely appears to be of clinical significance. We describe a case of acute, profound, hyponatraemia with confusion and convulsions developing in the context of seemingly uncomplicated plasmodium falciparum malaria. We draw attention to this rarely reported and poorly documented life-threatening complication and review the limited literature on the subject. ( info) |
14/50. malaria deaths in the united states: case report and review of deaths, 1979-1998. malaria is the world's most important parasitic disease, accounting for an estimated 300 to 500 million new cases and between 1.5 and 2.7 deaths annually. The majority of these deaths occur in sub-Saharan africa where malaria is endemic and are the result of infection with plasmodium falciparum. The number of deaths in the united states due to malaria is comparably much lower and involves so-called "imported" cases in which U.S. travelers acquire the infection upon travel to endemic areas and subsequently return to the united states or in which infected foreign citizens travel to the united states. There were a total of 118 deaths due to malaria in the united states between 1979 and 1998 with an average of 5.9 deaths per year. Specific epidemiological data provided by the CDC regarding the 40 deaths that occurred between 1992 and 1998 yielded the following results. Deaths occurred in patients ranging from 9 months to 89 years of age (median, 53 years). Thirty-eight (95%) of these were due to P. falciparum and two (5%) due to P. vivax. Anti-malarial chemoprophylaxis was taken in 40% of cases, not taken in 45% of cases, and unknown in 15% of cases. Twenty-four (60%) of the cases involved U.S. travelers to endemic areas, of whom 59% traveled to africa, 25% to south america, 8% to india, 4% to haiti, and 4% to unspecified areas. The remaining cases included eleven foreign travelers to the U.S. (27.5%), three induced cases (7.5%), and two undetermined cases (5%). Thirty-nine (98%) of the cases were diagnosed antemortem and only one case was known to have come to the attention of the medical examiner/coroner. An illustrative case report demonstrates many of the features associated with fatal malaria infections in the united states. The case involves a U.S. student who was studying in africa and who, by report, had not taken antimalarial chemoprophylaxis. Despite seeking medical attention, the patient was not diagnosed with P. falciparum infection and cerebral malaria until the time of medico-legal autopsy, where the classic gross and microscopic features of cerebral malaria were identified. This case represents one of the few cases of P. falciparum infection in the united states not diagnosed antemortem. Given the worldwide prevalence of the disease, increasing international travel, and rapidly developing drug resistance, malaria will continue to be an important disease and should be considered in cases of sudden, unexplained deaths. By reviewing the major epidemiological features of malaria-related deaths in the united states and by presenting the major gross and microscopic features of cerebral malaria, an attempt is made at raising the awareness of the forensic community to the potential of malaria-related deaths. ( info) |
| The neuropsychiatric manifestations of postmalaria neurological syndrome (PMNS) that have been described are highly variable and include an acute confusional state or acute psychosis with >or=1 of the following symptoms: clouding of consciousness, inappropriate speech or behavior, visual hallucination, catatonia with waxy flexibility, generalized convulsion, fine postural tremor, and decreased muscle tone. This postinfectious syndrome occurs after the clearance of parasitemia and is not a manifestation of cerebral malaria. We present the first identified case of and magnetic resonance imaging findings for a patient with PMNS in the united states. ( info) |
16/50. plasmodium falciparum cerebral malaria complicated by disseminated intravascular coagulation and symmetrical peripheral gangrene: case report and review. The case of a 56-year-old female tourist who survived cerebral plasmodium falciparum malaria with disseminated intravascular coagulation and symmetrical peripheral gangrene, ultimately requiring amputation of her left-sided fingertips and toes, is reported. While symmetrical peripheral gangrene has been described rarely in Asian, African, and American patients with plasmodium falciparum malaria and disseminated intravascular coagulation, no such case has been reported in travelers returning from endemic areas. ( info) |
| malaria has become a very uncommon disease in italy. Recently a variety of circumstances, such as travel to tropical countries as well as immigration from asia and africa, have combined to increase the number of malaria cases recorded annually. In this report we describe the use of red cell exchange transfusion and plasma exchange in the treatment of a patient with hyperparasitemic malaria (51% erythrocytes or more parasitized). When first observed the patient was in shock and had signs of cerebral malaria, disseminated intravascular coagulation, and acute respiratory distress syndrome, which in the following 2 days were complicated by acute renal failure. After mefloquine therapy combined with 3 red blood cell exchanges, 2 plasma exchanges, and 10 dialysis sessions over 14 days, the patient recovered completely. This case of severe malaria with multiple complications, treated with mefloquine in conjunction with both exchange transfusion and plasmapheresis, had a successful outcome and lends further support to the possible beneficial role of exchange transfusion in complicated malaria. ( info) |
| A 24-year-old Japanese man showed neurological disturbances 2 weeks after complete recovery from plasmodium vivax infection. Magnetic resonance (MR) images of the brain showed multiple high-intensity spotty lesions in the left cerebral cortex and subcortex. cerebrospinal fluid examination, including polymerase chain reaction analysis for viruses, revealed no sign of active infection. Repeated blood smears were negative for malaria. We diagnosed acute disseminated encephalomyelitis (ADEM) following plasmodium vivax malaria from the clinical course and MR images. ADEM should be regarded as one of the neurological complications after malarial infection. ( info) |
19/50. Fatal malaria in a German couple returning from burkina faso. We report on a German couple found dead at home 7 days after returning from burkina faso. Postmortem evaluation revealed plasmodium falciparum infection with a parasitemia of approximately 80% in both cases. No pathological findings of the organs were present at autopsy except moderate splenomegaly in both cases and myocarditis in one case. Typical findings of fatal malaria like petechial hemorrhages of the brain or other organs, or sequestration of parasitized erythrocytes in venules and capillaries were absent. Lack of sequestration with excessive hyperparasitemia leading to systemic hypoxemia and host cytokine release may have contributed to the rapid fatal course in these nonimmune patients. ( info) |
| A case of quinine-resistant plasmodium falciparum malaria, followed by a postmalaria neurological syndrome and a recurrence episode, is described. Genetic characterization of the P. falciparum isolate obtained by analysis of msp1 and msp2 amplicons revealed the coexistence of two genotypes causing the first malaria episode and the presence of a unique isolate responsible for the recurrence. ( info) |