DOI: http://dx.doi.org/10.18203/2349-3933.ijam20180067

Study of neurological manifestations in patients of falciparum malaria

Malati Murmu, Ayaskanta Kar, Karun Mahesh KP, Manoranjan Naik, Rajesh Kumar Meher

Abstract


Background: Several types of neurological manifestations are associated with falciparum malaria. Cerebral malaria is one of the most dreaded complications. A significant number of survivors are left with disabling neurological sequelae, most of which are self-limiting. Neurological involvement is more frequent with falciparum malaria because of its unique characteristics leading to micro-vascular involvement.

Methods: Present study was conducted at department of General Medicine, VIMSAR, Burla (Odisha). This observational study included in total 110 patients, who were confirmed cases of falciparum malaria. Clinical profile including detailed neurological examination with relevant investigations was done. Spectrum of neuropsychiatric manifestations were observed.

Results: Out of 110 patients male and female ratio was 1:1 (M 55 and F 55). The mean age of presentation in male was 36.09 + 14.85 yrs. and in female was 31.85 + 14.00 yrs. The major presenting symptoms were fever, headache, vomiting, altered sensorium, altered behaviour and convulsions in their decreasing order of frequency. On neurological evaluation, diminished level of consciousness was found in 56.4% cases. 14% cases had GCS score ≤ 7 and 63% had GCS score ≥ 11. Convulsion was found in 31% cases, cranial neuropathy in 10.9%, cerebellar dysfunction in 12.7%, neck rigidity in 22.7%, speech abnormality in 3.6%, peripheral neuropathy in 8.2%, fundoscopic changes suggestive of retinal involvement in 44.5% cases. Atypical manifestation like; Intracerebral haemorrhage, subarachnoid haemorrhage, cortical venous sinus thrombosis were also found in few cases. 32.72% patients had Neuropsychiatric manifestations at discharge in the form of focal neurological deficits, psychosis, depression, speech disorder, memory loss, cerebellar abnormality & peripheral neuropathy.

Conclusions: Neurological manifestations in falciparum malaria patients are common and encompass a wide spectrum of clinical presentation. In an endemic area, falciparum malaria should be kept as a differential diagnosis in patients presenting with atypical neurological manifestations.


Keywords


Falciparum malaria, Neuropathy, Sensorium

Full Text:

PDF

References


National Vector Borne Disease Control Programme, Directorate General of Health Services, Ministry of Health and Family Welfare, Malaria Situation in India (State-wise) from 2010-2017.http://nvbdcp.gov.in/malaria3.html.[Accessed 17Nov 2017].

Kochar DK, Kumawat BL, Kochar SK, Halwai M, Makkar RK, et al. Cerebral malaria in Indian adults. J Assoc Physicians India. 2002;50:234-41.

Idro R, Kakooza-Mwesige A, Balyejjussa S, Mirembe G, Mugasha C, Tugumisirize J, et al. Severe neurological sequelae and behaviour problems after cerebral malaria in Ugandan children. BMC research notes. 2010;3(1):104.

Senanayake N, deSilva HJ. Delayed cerebellar ataxia complicating falciparum malaria:a clinical study of 74 cases. J Neurol. 1994;241:456-45.

Leopoldino JF, Fukujima M, Gabbai AA. Malaria and stroke: case report. Arquivos de neuro-psiquiatria. 1999;57(4):1024-6.

Tin-Oo P. Gender, mosquitoes and malaria: implications for community development programmes in Laputta, Myanmar. Southeast Asian Journal of Tropical Medicine and Public Health, Sept 2001;32(3):588-94.

Brabin L, Brabin BJ. HIV, malaria and beyond: reducing the disease burden of female adolescents. Malaria Journal. 2005;4(1):2.

Dash SS, Mohapatra MK. Neuro-psychiatric manifestations in patients of falciparum malaria.(Degree of Medicine dissertation, Sambalpur University); 2006

Patil VC. Complicated falciparum Malaria in western Maharashtra Trop Parasitol. 2012 Jan-Jun; 2(1): 49-54

Wasnik PN, Manohar TP, Humaney NR, Salkar HR. Study of clinical profile of falciparum malaria in a tertiary referral centre in Central India. J Assoc Physicians India. 2012;60:33-6.

Singh VB, Kumar H, Meena BL, Chandra S. Neuropsychiatric Profile in Malaria: An Overview. Journal of clinical and diagnostic research: JCDR. 2016;10(7):OC24.

Mishra SK, Mohanty S, Satpathy SK, Mohapatra DN. Cerebral malaria in adults-a description of 526 cases admitted to Ispat General Hospital in Rourkela, India. Ann Trop Med Parasitol. 2007;101:187-93.

Bajiya HN, Kochar DK. Incidence of outcome of neurological sequel in survivors of cerebral malaria. J Assoc Physicians India. 1996;44(10):679-81.

Laloo DG, Trevett AJ, Paul M, Korinhona A. Severe and complicated falciparum malaria in Melanesian adult in Papua New Guinea. American J Trop Med Hyg. 1996;55:119-24.

White NJ, Loaresuwan S, Philips RE. Single dose phenobarbitone prevents convulsion in cerebral malaria. Lancet. 1988;11:64-66.

Varney NR, Roberts RJ, Springor JA, Connel SK. Neuropsychiatric sequel of cerebral malaria in Vietnam. J Nerv Ment Dis. 1997;185(11):695-705.

Manyike PC, Okike C, Onyire NB, Chinawa JM, and Austin-Abu JU. Cerebral Malaria Complicated by Blindness, Deafness and Extrapyramidal Tract Manifestation. Ann Med Health Sci Res. 2015;5(4): 321-2.

White NJ, Loaresuwan S. Cerebral malaria in Kennedy PGE, Johnson RI, Eds of nervous system. London: Butter Worths; 1987;118-43.

MC Walker, MD O’Brien Neurological examination of the unconscious patients. J R Soc Med. 1999;92:353-5.

Nguyen Thi HM, Nicholas PJ, Day Ly, Van Choung. Post malarial neurological syndrome. Lancet. 1996;348:917-21.

Russell PF, West LS, Manwell RD, Macdonald G. Practical malariology. Practical Malariology. (Ed 2); 1963

Sarvepalli AK, Dharana PK. Clinical profile, laboratory profile of malaria cases attending a tertiary care hospital in South India: two-year study. Int J Adv Med. 2017;4:540-5.

Mathur SL, Hakim A, Ladha R. Subarachnoid haemorrhage in falciparum malaria. An unreported presentation. J Assoc Physicians India. 1992;40:348.

Murugavel K, Saravanapavananthan S, Anpalahan A. Subarachnoid haemorrhage in Plasmodium falciparum malaria Postgrad Med J. 1989;65:236-7.

Sharaswal DK. A case of cerebral malaria presenting as subarachnoid haemorrhage. J Assoc Physicians India. 1994;42:756.

Gall C, Spuler A, Fraunberger P. Subarachnoid hemorrhage in a patient with cerebral malaria. N Engl J Med. 341;1999:611-3.

Moxon CA, Heyderman RS, Wassmer SC. Dysregulation of coagulation in cerebral malaria. Molecular and biochemical parasitol. 2009;166(2):99-108.

Luvira V, Chamnanchanunt S, Thanachartwet V, Phumratanaprapin W, Viriyavejakul A. Cerebral venous sinus thrombosis in severe malaria. Southeast Asian J Trop Med Public Health. 2009;40(5):893-7.

Krishnan A, Karnad DR, Limaye U, Siddharth W. Cerebral venous and dural sinus thrombosis in severe falciparum malaria. J Infect. 2004;48:86-90.

Kochar DK, Kumawat BL. Ophthalmoscopic abnormalities in adults with falciparum malaria. QJ Med. 1998;91(12):845-52.

Looareesuwan S, Warrell DA, White NJ, Chanthavanich P. Retinal hemorrhage, a common sign of prognostic significance in cerebral malaria. Am J Trop Med Hyg. 1983;32(5):911-5.

Thumasupapong S, Tin T, Sukontason K, Sawaddichi C. electroencephalography in cerebral malaria. Southeast asian J Trop Med public health 1995:26(1):34-7.

Jakka SR, Veena S, Atmakuri RM, Eisenhut M. Characteristic abnormalities in cerebrospinal fluid biochemistry in children with cerebral malaria compared to viral encephalitis. Cerebrospinal Fluid Res. 2006;3:8

Berkley JA, Mwangi I, Mellington F, Mwarumba S, Marsh K. Cerebral malaria versus bacterial meningitis in children with impaired consciousness. Qjm. 1999;92(3):151-7.

Drago SD, Sa ND, Golapalli U. Guillian Barre Syndrome in a case of falciparum malaria. J Assoc Physicians India. 1997;45:161.