People dying of malaria … that’s over a million deaths a year. But there are ten times, 20 times, 100 times more people that develop severe complications of malaria that are desperately life threatening but do survive. And as part of this survival, there are risks … from behavioral disturbances and difficulties in learning through to very severe disabilities such as spasticity, total paralysis down one side of the body … to deafness and blindness and epilepsy. Many of those children with epilepsy may die because they fall into fires or down wells.”

Bob Snow, Kenya Medical Research Institute (2002)

Hypoglycemia

Prolonged hypoglycemia can produce death and/or chronic neurologic damage. Hypoglycemia associated with falciparum malaria (defined as a blood glucose concentration of less than 2.2 mmol/L or 40 mg/dL) has two discrete etiologies. It may reflect metabolic acidosis (i.e., hyperlactatemia) seen in severe malaria or, in quinine-treated patients, it may reflect quinine-stimulated insulin secretion. Metabolic acidosis is usually present on admission to the hospital and carries a poor prognosis, while hyperinsulinemia tends to appear after the first 12 to 24 hours of treatment (White et al., 1983).

In one study, 13 to 32 percent of children with severe malaria developed hypoglycemia as a complication of their illness (Taylor et al., 1988).

Severe Malaria in Adults versus Children

Most cases of severe malaria in adults occur in regions outside Africa. However, even in malaria-endemic areas of Africa, some adults still suffer and die from severe malaria. The clinical spectrum of illness in these individuals is different from that seen in children. Whereas children are more likely to develop severe anemia, hypoglycemia, or convulsions, adults with severe malaria are more likely to develop jaundice, acute kidney damage, or acute pulmonary edema. Recovery from cerebral malaria in adults is slower than in children although neurologic sequelae are less frequent (occurring in less than 3 percent of adult cases compared with 10 percent of pediatric cases). Kidney failure due to acute tubular necrosis is another important cause of death. Acute pulmonary edema in malaria results from increased capillary permeability, the same pathophysiologic process that leads to acute respiratory distress syndrome. The mortality of severe falciparum malaria in adults who are appropriately treated can reach 15 to 20 percent.



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