Document Type : case report
Authors
1 Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Infection Control and Hand Hygiene Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract
Malaria is a life-threatening disease caused by Plasmodium species, with Plasmodium falciparum being the most virulent form. Cerebral malaria is a severe complication that can lead to various neurological manifestations. We report the case of an 8-year-old boy who presented with an unusual symptom of cerebral malaria—spastic gait. Diagnostic workup included a positive malaria rapid diagnostic test (RDT) and peripheral blood smear (PBS), confirming P.falciparum infection. Brain MRI revealed high signal intensities in the bilateral globus pallidus, consistent with cerebral involvement. The patient received intravenous Artesunate and a combination of antimalarial medications including Coartem, Primaquine, Quinine, and Clindamycin. He showed significant clinical improvement following treatment. This case highlights a rare neurological presentation of cerebral malaria and emphasizes the importance of early diagnosis and prompt treatment. Additionally, it underscores the value of neuroimaging, particularly MRI, in confirming cerebral involvement in atypical clinical presentations.
Keywords
- Castaldo N, Tascini C, Della Siega P, Peghin M, Pecori D. Clinical presentation and immunological features of Post-Malaria Neurologic Syndrome: a case report and review of literature. Malaria Journal. 2020 Dec;19:1-1.
- Hijazi M, Abdalla E, Fadul A, Eltayeb DA, Al-Mashdali A. Malaria causing post-infectious cerebellitis, a case report and literature review. Annals of Medicine and Surgery. 2022 Sep 1;81.
- Hora R, Kapoor P, Thind KK, Mishra PC. Cerebral malaria–clinical manifestations and pathogenesis. Metabolic brain disease. 2016 Apr;31:225-37.
- Akide Ndunge OB, Kilian N, Salman MM. Cerebral malaria and neuronal implications of plasmodium falciparum infection: From mechanisms to advanced models. Advanced Science. 2022 Dec;9(36):2202944.
- Pielok L, Kludkowska M, Rzymski S, Stefaniak J. Cerebral malaria and multi-organ dysfunction in an adult woman with Plasmodium falciparum infection imported from Cameroon: a case report. Annals of Parasitology. 2019;65(4).
- Albrecht-Schgoer K, Lackner P, Schmutzhard E, Baier G. Cerebral malaria: current clinical and immunological aspects. Frontiers in immunology. 2022 Apr 20;13:863568.
- Tegegne Y, Worede A, Derso A, Ambachew S. The Prevalence of Malaria among Children in Ethiopia: A Systematic Review and Meta‐Analysis. Journal of Parasitology Research. 2021;2021(1):6697294.
- Trivedi S, Chakravarty A. Neurological complications of malaria. Current neurology and neuroscience reports. 2022 Aug;22(8):499-513.
- Oluwayemi OI, Brown BJ, Oyedeji OA, Adegoke SA, Adebami OJ, Oyedeji GA. Clinical and laboratory predictors of outcome in cerebral malaria in suburban Nigeria. The Journal of Infection in Developing Countries. 2013 Aug 15;7(08):600-7.
- Shahbodaghi SD, Rathjen NA. Malaria: prevention, diagnosis, and treatment. American family physician. 2022 Sep;106(3):270-8.
- White NJ. Severe malaria. Malaria journal. 2022 Oct 6;21(1):284.
- Potchen MJ, Kampondeni SD, Seydel KB, Birbeck GL, Hammond CA, Bradley WG, et al. Acute brain MRI findings in 120 Malawian children with cerebral malaria: new insights into an ancient disease. American Journal of Neuroradiology. 2012 Oct 1;33(9):1740-6.
- Ashley EA, Poespoprodjo JR. Treatment and prevention of malaria in children. The Lancet Child & Adolescent Health. 2020 Oct 1;4(10):775-89.
- Garchitorena A, Harimanana A, Irinantenaina J, Razanadranaivo HL, Rasoanaivo TF, Sayre D, et al. Expanding community case management of malaria to all ages can improve universal access to malaria diagnosis and treatment: results from a cluster randomized trial in Madagascar. BMC medicine. 2024 Jun 10;22(1):231.
- Goodwin J, Kajubi R, Wang K, Li F, Wade M, Orukan F, et al. Persistent and multiclonal malaria parasite dynamics despite extended artemether-lumefantrine treatment in children. Nature Communications. 2024 May 7;15(1):3817.
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