Cerebral Malaria in Children: A Review of ... - Sudanjp.org

SUDANESE JOURNAL OF PAEDIATRICS AND CHILD HEALTH VallO: 2010transfusions remains highly controversial, as they areboth expensive and potentially dangerous in manymalaria-endemic areas.Pentoxifylline helps microcirculatory flowby reducing the red cell deformability and bloodviscosity, decreases systemic vascular resistanceand impairs platelet aggregation thus improvingmicrocirculatory flow.Desferrioxamine this is an iron-chelating adjuvantagent with antimalarial properties is suggested as itreduces the formation of reactive oxygen species byreducing amount of free iron.52The following drugs should not be administered:Anti-Inflammatories such as corticosteroids.However, there have been few controlled studiesdemonstrating benefit. other antiinflammatory drugs;low molecular weight dextran; adrenaline; heparin;hyperbaric oxygen; cyclosporin should be avoided.Dehydration and hypovolemia in children withcerebral malaria should be corrected with intravenousfluids or colloid. Lactic acidosis can be correctedby aggressive management of malarial infection,volume replacement if the patient is dehydrated andtransfusion of blood as appropriate.The mortality of untreated severe malaria can be100%, but with antimalarial treatment, the overallmortality falls to 15-20%. As death from severemalaria can occur within hours of admission tohospital or clinic, it is essential that therapeuticconcentrations of antimalarial are achieved as soonas possible with intravenous antimalarials. Further,gastrointestinal intolerance and erratic intestinalabsorption make the oral route of administrationunreliable in these patients. As resistance toantimalarial drugs can complicate matters further,proper choice of antimalarials to start the treatmentis of utmost importance; changing the drugs oradding of drugs half-way through the treatment onlycomplicates the issue and adds to the adverse effectsof treatment. Children with cerebral malaria shouldbe treated with intravenous or intramuscular Quinine,or intramuscular Artemisinin derivatives.53Consequences and Prognosis of Cerebral MalariaCerebral malaria carries a mortality of around 20%in adults and 15% in children. Factors associated witha fatal outcome included deep breathing or acidosis(base excess below -8), hypotension (systolic bloodpressure < 80mmHg), raised plasma creatnine (>80]tmolll), low oxygen saturation «90%), dehydrationand hypoglycaemia «2.5 mmolll). Approximately7% of children who survive CM are left withpermanent neurological problems. These includeweakness, spasticity, blindness, speech problemsand epilepsy. Recent evidence suggests that somechildren who appear to have made a completeneurological recovery from cerebral malaria maydevelop significant cognitive problems (attentiondeficits, difficulty with planning and initiating tasks,speech and language problems), which can adverselyaffect school performance and persist for years afterthe attack.54 The limited availability of specializedcare for such children indicates that opportunitiesfor subsequent learning and for attainment ofindependence, are compromised even further.References1- Newton. CR.1nteraction between Plasmodium falciprum andhuman immunodeficiency virus type 1on the central nervoussystem of African children.».I Neurovirol 2005; 11 suppl 3:4551-.2--Luhan, M. Malaria. WHO Press Office fact sheet 94. P. 1-3.World Health Organization, Geneva, Switzerland. 1996.3- WHO. Current epidemiological situation.TDR Roll BackMalaria. Report: 2002.4- Chin, 1. (Ed.) (2000). Control of communicable diseasesmanual (17th ed.). Washington, DC: American Public HealthAssociation.21