Cerebral malaria

Abstract

Malaria remains of significant public health concern under the tropics, causing millions of deaths annually. The disease is caused by protozoans of the Plasmodium genus, of which harbors several distinct species. Human infection occurs during the blood meal of an infected female mosquito belonging to the Anopheles genus. It is estimated that around 1% of children infected with Plasmodium falciparum develops a more severe form of malaria, which may eventually lead to cerebral complications including cerebral malaria (CM). CM can be positively diagnosed in patients unable to localize a painful stimulus, with peripheral asexual P. falciparum parasitemia and no other identifiable causes of an encephalopathy. Unarousable comas along with the presence of asexual forms of the parasite on a peripheral blood smear are hallmarks of the disease. While the molecular mechanisms underlying the pathogenesis of CM have yet be fully elucidated, the pathology in itself indicates a clear disease of the vascular endothelium. It is characterized by parasite sequestration, inflammatory cytokine production and vascular leakage, eventually resulting in brain hypoxia. The condition requires systemic health management consisting of focused nursing practices, supportive care, and anti-malarial drugs. The continued understanding of pathogenic mechanisms leading to the onset of CM is fundamental and key for the expansion and development of appropriate neuroprotective interventions. Future research perspectives may also include the development of field-based and rapid diagnostic tests for CM, understanding of host-pathogen interactions to advance development of prevention tools and therapies, and antimalarial drug trials.

Keywords: Cerebral malaria; Plasmodium falciparum; Tropical neurology.