Pernicious malaria

MALARIA

1. PERNICIOUS MALARIA PRESENTER :Dr S anthosh kumar

2. a series of phenomena occuring during the course of an infection of P.falciparum which ,if not effectively treated, threatens the life of the patient within 1 to 3 days.

3. PATHOGENESIS: serious complications that may develop in “pernicious malaria” are the result of capillary blockage consequent upon decreased effective circulating blood volume. the blockade of the capillary blood vessels of the internal organs arises from agglutination of parasitised erythrocytes.

4. Peculiar biological features of P.falciparum : Recession of asexual parasites from the peripheral circulation to the capillary blood vessels of the internal organs for later stages of schizogony , Stickiness of infected erythrocytes in relation to vascular endothelium ,helping agglutination of erythrocytes and causing occlusion of capillary blood vessels.

5. Studies considers that stasis results from vasoconstriction, due to sympathetic hyperactivity plays an important role in capillary blockage. Stasis means loss of fluid from vessels( hypovolemia ) due to increased permeability of the endothelial cells allowing heavy molecules and water to pass through, leading to increased blood viscosity and concentration of circulating erythrocytes which contain mature schizonts . Pernicious manifestations may be anticipated when >5% of red blood cells are parasitised .

6. MANIFESTATION CEREBRAL MALARIA Hyperpyrexia, coma, paralysis. ALGID MALARIA characterised by cold and clammy skin with vascular collapse leading to peripheral circulatory failure. Gastric type- presents with vomitings Choleraic type- watery diarrhoea Dysenteric type- passage of blood in faeces SEPTICAEMIC MALARIA continous high temp, pneumonia,cardiac syncope.

7. PATHOLOGY CEREBRAL MALARIA Brain capillary network is distended and plugged by parasitised erythrocytes Prominent in grey matter All stages of erythrocytic cycle may occur in capillaries Focal symptoms may be associated. Microscopic picture may reveal Dilatation and congestion of cerebral capillaries filled with parasitised erythrocytes

8. Perivascular haemorrhages , Scattered areas of softening due to degeneration of the nervous tissue. Softened areas invaded by glial cells forming malarial granulomas Permanent damage in form of multiple sclerotic areas may remain in the brain as a sequel to malarial infection.

9. ALGID MALARIA Gastro-intestinal tract mucous membrane shows slate grey color. Punctate haemorrhages , intestinal contents may be watery or dark brown with very little mucus Mucous and sub mucous capillaries are congested and packed with parasitised erythrocytes . 2 . Peripheral blood vessels . Generalised vascular collapse resulting from adrenal damage or occurs independantly . 3 Adrenal glands necrosis of zona fasciculata and haemorrhages with congestion of zona reticulata .

10. SEPTICAEMIA MALARIA HEART Congested coronary blood vessels filled with parasitised erythrocytes. Fatty degeneration and necrosis of heart muscles may occur. LUNG Haemorrhages with patches of oedema and collapse. Alveolar capillaries are found to be congested and filled with parasitised erythrocytes . Alveoli contain extravasated RBCs and pigmented monocytes

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