Question

45yo male returned from a trip to the Ecuadorian Amazon with high fever, headache, and intermittent diarrhea. On exam his temperature was 40.3°C, and his spleen tip was palpable. Lab tests showed a normal WBC count but a mild anemia and a serum creatinine level of 1.8mg/dL (normal is <1.2mg/dL). The astute physician who saw him in the emergency department ordered a blood smear for malaria. The smear showed multiple small “ring” forms in erythrocytes of all ages and multiple cells infected by >1 parasite. Before the patient could be given antimalarial treatment, he had a grand mal seizure and lapsed into a coma. What was the likely reason for the seizure?

Answer 1

Impaired blood flow to cerebral venules

Malaria is caused by malarial parasites which cause extremely high fevers and shaking chills by infecting and reproducing inside human red blood cells. The parasites are transmitted between humans and mosquitoes when an infected mosquito bites a human the parasites travel with mosquitoes saliva into human blood stream the parasites travel to liver where they mature into a form capable of infecting red blood cells the mature parasites burst out of live cells into blood stream where they quickly invade red blood cells during this process the outer membrane of red blood cells fold inwards to form a sac called vacuole around parasites and the red blood cells filled with parasites block the blood vessels obstructing the blood flow to brain which leads to seizures.