A Case of Cerebral Malaria Reminds us to Remain Vigilant in our Fight Against Malaria

An 18 year-old man is currently recovering from cerebral malaria under the care of Mae Tao Clinic and Shoklo Malaria Research Unit (SMRU).

The patient, originally from Rangoon, is a migrant worker (furniture welder) in the Myawaddy area. Recently, while working on a temple in a rural part of Myawaddy Township he developed a fever. Two days later his co-workers found him unconscious. 

They returned him to Myawaddy town where he was diagnosed with meningitis, however after not being able to find the recommended medicine for treatment in the market, his family decided to take him to Mae Tao Clinic (a local clinic that offers free health care for migrants) where he was subsequently diagnosed with P. falciparum malaria. 

Because the parasites infecting him were only slowly being cleared by intravenous artesunate, the standard treatment for severe malaria (see graph), the clinic staff contacted SMRU for additional assistance. Dr Aung Pyae Phyo, whose research focuses particularly on drug resistant malaria and the management of artemisinin resistant P. falciparum malaria, added an intravenous injection of Quinine as a pre-emptive therapy, rescuing him from the artesunate resistant parasites.

Image: Patient recovering from cerebral malaria © SMRU/Photo by Suphak Nosten
Patient recovering from cerebral malaria
© SMRU/Photo by Suphak Nosten

Graph: Patient (red line) parasite clearance over time © SMRU
Graph: Patient (red line) parasite clearance
over time © SMRU

Slide Image: Hyper-parasitemia (P. falciparum) under microscope © SMRU
Hyper-parasitemia (P. falciparum)
under microscope © SMRU

This young man is the only child of a single mother and he has been a migrant worker since he was 11 years old, helping to bring in a paycheck for his family.  He was unfortunate to have been exposed to malaria on the Thai-Myanmar border, but extremely fortunate to currently be recovering from cerebral malaria. This case illustrates the importance of quickly seeking diagnosis and treatment for febrile illnesses. 

In the town of Myawaddy, as in many other locations on the Thai-Myanmar border, malaria is mostly a memory. It can be treated if diagnosed properly and in a timely manner but it is important for medics and other health staff to ask questions regarding a fever patient's recent travel to rural areas, where transmission is still occurring, and to test the patient for malaria. 

Malaria hides in remote locations, where populations have difficulty accessing treatment and can re-emerge from these locations if we aren’t vigilant. A strong component of malaria elimination programs is access to early diagnosis and treatment, which generally prevents transmission if taken within 48h of fever onset.

 

Contact

Shoklo Malaria Research Unit
68/30 Bantung Road, PO Box 46
Mae Sot, Tak 63110 Thailand

Tel: +66 (0) 55 532 026
       +66 (0) 55 532 028
Fax: +66 (0) 55 532 027
Email SMRU

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