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Pathophysiology of severe falciparum malaria in man

Published online by Cambridge University Press:  23 August 2011

D. A. Warrell
D. A. Warrell
Affiliation:
Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Headington, Oxford OX3 9DU
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Extract

The term severe falciparum malaria implies an infection with manifestations and complications which are potentially fatal in man, the natural host for this parasite. Much that has been written on the pathophysiology of animal malarias is of doubtful relevance to the understanding of the mechanism of Plasmodium falciparum infection in man. The clinical picture of severe P. falciparum infection differs in several respects from severe animal malarias, even those of non-human primates. Cerebral dysfunction is the most common severe manifestation of falciparum malaria in man. Coma develops suddenly after a generalized convulsion or gradually towards the end of the first week of illness. There are signs of a symmetrical upper motor neurone lesion and brain-stem dysfunction, but only about 5% of survivors show persisting neurological deficit after 2 or 3 days of unconsciousness. The mortality of cerebral malaria depends on how it is defined and on the predominant age group and other factors. In patients with proved acute P. falciparum infection with unrousable coma, in whom other causes of encephalopathy have been excluded, the mortality is between 15 and 50% despite treatment with antimalarial drugs (Warrell, Looareesuwan, Warrell, Kasemsarn, Intaraprasert, Bunnag & Harinasuta, 1982).

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Research Article
Information
Parasitology , Volume 94 , supplement S1: Symposia of the British Society for Parasitology Volume 24 Pathophysiological responses to parasites , January 1987 , pp. S53 - S76
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Copyright © Cambridge University Press 1987

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