DEMYELINATION FOLLOWING MALARIA

Neurological sequalae in complicated malaria.


Acute Demyelination of brain and peripheral nerves are seen with viral, bacterial infection or following immunization but uncommon finding following parasitic infection. Some people have reported GBS following malaria.(1)
DKKochar(2) et all have reported some case of Demyelination following severe malaria, Pseudo bulbar paralysis following malaria have been reported by Mohapatra et(3) all as a sequalae of complicated malaria.
Here we report a case of Demyelination in a case of complicated malaria.
Our patient 55 years old man with multiorgan involvement and positive Vivax and Falciparum malaria(parasite index >15%) was referred from a mining area, in a comatose state (GCS#3) and frequent generalized tonic clonic seizures.Neurologiacl examination showed multiple cranial nerve involvement and bilateral up going planter. The CT scan picture showed areas of hypo dense areas involving pons, midbrain and bilateral basal ganglia. This was suggestive of Myelinolysis, cerebral edema with multiple cerebral infarcts.This could be because of malaria or due to artisunate is difficult to opine.More research is required in this line.

The mortality rate in most of the referral hospitals in the capital city of Odissa, Bhubaneswar, is high despite intensive ICU care, early hemodialysis, blood transfusion and ventilator support due to late referral of cases with multiorgan failure. In recent years the mortality rate of complicated malaria continues to be a problem area for physicians. The reason may be due to late diagnosis, improper therapy, poverty, immunological reaction and multiorgan involvement.
Our observation is, patients requiring ventilator have a high mortality rate. In spite of rampant use of artemesinins compounds even by quacks the mortality is on the rise in cases of complicated Falciparum malaria all over Odissa (earlier Orissa).
I do not know if my colleagues will agree with me or not.
Ref:
1. KanjalkarM, KarnadDR, GBS following malaria.J.Infection1999; 38:48-50.
2. ConnerDH, HerberJM, Parasite infection of the peripheral nervous system,DyckPJ,ThomasPK,WBSaunders,1993p,1338-90
3. Pseudobulbar paralysis: MKMohapatra, GSethi, And SCMohanty: Demyelination a pathological sequalae of severe malaria.
4: DKKochar, PSirohi, SKKochar, Bikaner, Rajastan, India