تظاهری جدید از مالاریای مغزی
کد: G-1054
نویسندگان: مهدیه خراشادی زاده ℗, فاطمه ذاکرتولایی ©
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خلاصه مقاله:
خلاصه مقاله
Malaria is a worldwide parasite infection with different types of symptoms caused by plasmodium species. Plasmodium falciparum is accountable for more severe illness and deaths. One of the most onerous presentations of plasmodium falciparum is cerebral malaria (CM) or neuromalaria. An 8-year-old boy, presented with five days of fever, chills, headache and abdominal pain.Then, he developed impaired walking balance and spastic gait. Two weeks ago, he had a trip to Pakistan with his father with no chemoprophylaxis taken. On examination, he was positive for splenomegaly. His cranial nerves and cerebellar tests were normal and he had no signs of meningeal irritation. On the motor inspection, he showed rigidity in all limbs and the patellar reflex was +3. During hospitalization, cause of status epilepticus he transferred to intensive care unit. Ct scan of brain reveals signs of brain swelling. During admission in ICU, his hemoglobin and platelets dropped with elevated LDH. So, he undergoes platelets and packed cell transfusion. We suspected cerebral malaria and we performed a malaria rapid diagnostic test (RDT) along with the thick and thin peripheral blood smear (PBS). The RDT was positive and in PBS Plasmodium falciparum were seen. He treated with continuous seven days of intravascular Artesunate and demonstrated a considerable clinical improvement. Due to not eradication of plasmodium in PBS, we treated the patient with Coartem in three doses and Primaquine in one dose in the last day of Coartem. We attached Quinine and Clindamycin as third line of therapy cause of severe invasion of the disease and treatment failure. Also, He was treated with Baclofen and Clonazepam as anti-spastic drugs and Levetiracetam as anti-convulsive. On the follow up, thirty hours after initiating treatment, his GCS improved to 11/15 and after two days it was 14/15. Cerebral malaria is more common in P.falciparum with different presentations that the most prominent symptoms are seizure and coma. Although we expect the walking disorders like ataxia as post malaria complications, in this research we revealed a novel presentation of neuromalaria, spastic or scissor's gait. This result can be a clue for the subsequent researches to discover its' pathophysiology.
کلمات کلیدی
Malaria,Plasmodium falciparum,cerebral malaria,spastic or scissor's gait
