Pediatric Cerebral Malaria: A Scourge of Africa

Abstract

Cerebral malaria, defined as an otherwise unexplained coma in a patient with Plasmodium falciparum parasitemia, affects up to 1 million people per year, the vast majority of them being children living in sub-Saharan Africa. Despite optimal treatment, this condition kills 15% of those affected and leaves 30% of survivors with neurologic sequelae. The clinical diagnosis is hampered by its poor specificity, but the presence or absence of a malarial retinopathy in cerebral malaria has proven to be important in the differentiation of underlying coma etiology. Both antimalarials and intense supportive care are necessary for optimal treatment. As of yet, clinical trials of adjunctive therapies have not improved the high rates of mortality and morbidity. Survivors are at high risk of neurologic sequelae including epilepsy, neurodisabilities and cognitive–behavioral problems. The neuroanatomic and functional bases of these sequelae are being elucidated. Although adjunctive therapy trials continue, the best hope for African children may lie in disease prevention. Strategies include bednets, chemoprophylaxis and vaccine development.

Keywords:

• Africa
• artesunate
• malaria
• pediatrics
• retinopathy
• vaccination

Financial & competing interests disclosure

Editor:

Elisa Manzotti, Publisher, Future Science Group.

Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.

CME author:

Laurie Barclay, Freelance writer and reviewer, Medscape, LLC.

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Authors & credentials:

Douglas G Postels, Michigan State University, East Lansing, MI 48824, USA.

Disclosure: Douglas G Postels has disclosed no relevant financial relationships.

Yamikani F Chimalizeni, Department of Pediatrics, University of Malawi College of Medicine, Private Bag 360, Blantyre 3, Malawi.

Disclosure: Yamikani F Chimalizeni has disclosed no relevant financial relationships.

Macpherson Mallewa, Department of Pediatrics, University of Malawi College of Medicine, Private Bag 360, Blantyre 3, Malawi.

Disclosure: Macpherson Mallewa has disclosed no relevant financial relationships.

Michael J Boivin, Michigan State University, East Lansing, MI 48824, USA.

Disclosure: Michael Boivin has disclosed no relevant financial relationships.

Karl B Seydel, Michigan State University, East Lansing, MI 48824, USA.

Disclosure: Karl B Seydel has disclosed no relevant financial relationships.

No writing assistance was utilized in the production of this manuscript.

Notes

Data taken from [37].

Additional information

Funding

Future Science Group.