Case Studies
Case 2.9 Cerebral malaria
A 44-year-old Nigerian man was admitted as an emergency while visiting relatives in England. His symptoms began 4 days after arrival, and over the following 10 days he deteriorated progressively, with vague upper abdominal pain, sweating, rigors and vomiting. In the past, he had been treated twice for malaria but had never taken malarial prophylaxis. On examination he was ill and jaundiced, with a temperature of 39.2°C. His blood pressure was 90/70 but he showed no signs of visceral perforation. The differential diagnosis included occult gastrointestinal bleeding, septicaemia, hepatitis or recurrence of malaria.
Emergency investigations showed a normal haemoglobin (140g/l) and a white cell count of 6.1 x 109/l. Sickle-cell anaemia was excluded by normal haemoglobin electrophoresis. However, a thick blood film showed a heavy infestation with Plasmodium falciparum. After consultation with a specialist centre, the patient was treated with intravenous quinine. Unfortunately, his condition rapidly deteriorated over the next 30h. Terminally, he suffered a cardiac arrest and could not be resuscitated. The post-mortem diagnosis was cerebral malaria.
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