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Life threatening intracranial hemorrhages in malaria
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This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.
Sir,
The article entitled “Extradural hematoma in plasmodium vivax malaria; Are we alert to detect?”, published in August 2013 online issue of our esteemed journal JNRP (Vol 4. issue 5, page 145-146), is an excellent documentation. In the same issue the commentary by S J Khan has further elaborated the condition. Here I would like to share my views which would further enlighten the condition.
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Malaria causes various hematological and hemorrhagic complications with thrombocytopenia, among which the ocular and the intracranial hemorrhagic complications are rare but are more so fatal compared to general bleeding complications
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If intracranial or subdural/extradural hematomas are not recognized and treated promptly with correction of associated hematological complications and evacuation of hematoma, it may be potentially fatal
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Vitreous hemorrhage may be an important cause of visual impairment in malaria patient besides cortical blindness and optic neuritis[1]
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In India, in the malaria post-resurgent era, the complications are not likely to occur as early as it used to occur in early 1990's outbreaks but, quite late after about an interval of a week or two, as it happened in this case, if the patient is not treated promptly in the initial stage. These complications are documented/observed in case of jaundice/hepatitis and renal failure as is the condition in the present case
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Thrombocytopenia is also a feature of severe malaria and most of the times decreased platelets counts are also associated with abnormal function. A correlation with severity of malaria with thrombocytopenia has also been described[23]
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The view expressed in the commentary that plasmodium vivax malaria may not be benign malaria was argued by Picot in 2006[4] is good but a landmark study in this subject was also documented by Kochar et al., in the same year[5]
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So there is a need of the hour to treat each and every patient of malaria at the onset of fever/first symptoms so as to avoid such complications.
References
- The changing spectrum of severe falciparum malaria: A clinical study from Bikaner (Northwest India) J Vector Borne Dis. 2006;43:104-8.
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- Is Plasmodium vivax still a paradigm for uncomplicated malaria? Med Mal Infect. 2006;36:406-13.
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