LETTERS TO THE EDITOR
Letters to the Editor Sir, Pitfalls in the Diagnosis of Malaria: A-parasitaemic Severe Malaria Mortality and morbidity from cerebral malaria may be reduced by prompt microscopic diagnosis. The cases illustrated below show that occasionally, initial diagnostic slides may be P.falciparum negative.
Case 2 R.M., a 4-year-old, 14-kg girl, referred with convulsions, fever, rigors, unrousable coma, and hepatomegaly. CSF and blood biochemistry were normal. Thick blood films taken on admission were negative for malaria parasites. She died within 2 h of admission before treatment. Post-mortem examination confirmed cerebral malaria. Case 3 Y.B., a 3-year-old, 10-kg girl with fever, cough, convulsions, and coma, was seen decerebrate and PCV of 21 per cent. The admission thick film was negative for P.falciparum, but positive 12 h later. A diagnosis of cerebral malaria was made at this point; she was treated with intravenous chloroquine and recovered fully.
A negative blood film made for diagnosis of severe malaria may be due to extensive vascular cytoadherence of the parasitized red cells.1 Previous reports have demonstrated this in the cerebral vessels of fatal cases, while parasites may be scanty peripherally.1 Synchronicity of infection and previous intake of antimalarials may also temporarily clear the peripheral blood of parasites. Poor techniques whilst making malaria slides may result in false negative slides.2 Therefore, careful examination of several slides at regular intervals (6- or 12-hourly) for parasites and pigments in white cells is advocated when cerebral malaria is suspected and the initial slide negative. O. WALKER, A. SOWUNMI, and L. A. SALAKO
Department of Pharmacology and Therapeutics College of Medicine University of Ibadan Ibadan Nigeria Acknowledgements This study received support from the UNDP/World Bank/WHO fund for Training and Research in Tropical Diseases. References 1. World Health Organization. Severe and complicated malaria. Trans Roy Soc Trop Med Hyg 1990; 84: Suppl 2. 2. Brooks MG, Karet F, Lewis DA, Chid A, Weir WRC. Interpretation of blood films in diagnosis of malaria. Lancet 1989; ii: 619.
Case 5 Y J., a 7-year-old girl (21 kg) presented in coma with a febrile illness. Blood films for malaria parasites on admission were negative. A provisional diagnosis of cerebral malaria was based on the finding of pigments
Sir, Unchecked commercialization of ORS—a road to disaster? WHO ORS was introduced as a single solution for the correction of all types of diarrhoeal dehydration with certain guidelines. However, ORS packets currently available are barely sufficient to provide rehydration therapy for 10 per cent of childhood diarrhoeal dehydration. 1 This has encouraged pharmaceutical companies to step in to meet the demand. However, to make their products unique, companies have started adding other ingredients freely. For increasing saleability, many of these peparations have been sweetened. Manufacturers have also taken the advantage of demand for ORS with different concentration of sodium. 2 The increase in cost and unawareness about
268
Journal of Tropical Pediatrics
Case 4 A.S., a 10-kg, 1-year-old girl seen with fever, convulsions, and unrousable coma. Thick blood films taken on admission after a normal CSF was negative for malaria parasites. Malaria pigments were found in the white cells. A provisional diagnosis of cerebral malaria was made and she was started on intravenous quinine. A 24-h blood film revealed numerous P. falciparum parasites. She therefore continued on quinine and recovered completely.
© Oxford University Press 1992
Vol.38
October 1992
Downloaded from http://tropej.oxfordjournals.org/ at University of Victoria on July 12, 2015
Case 1 R.A., a 24-kg, 9-year-old boy with a 3-h history of unrousable coma following a febrile illness was referred. Examination showed pallor, spasticity, and coma. A diagnostic blood film was negative for malaria parasites. His haematocrit (PCV) was 29 per cent; the cerebrospinal fluid (CSF) was normal. He was managed as viral encephalitis. He died within 12 h of admission. Post-mortem examination confirmed cerebral malaria.
in the white cells, and the patient was started on intravenous quinine. Twenty-four-hour blood films, revealed P.falciparum. She also recovered fully.
Letters to the Editor Sir, Pitfalls in the Diagnosis of Malaria: A-parasitaemic Severe Malaria Mortality and morbidity from cerebral malaria may be reduced by prompt microscopic diagnosis. The cases illustrated below show that occasionally, initial diagnostic slides may be P.falciparum negative.
Case 2 R.M., a 4-year-old, 14-kg girl, referred with convulsions, fever, rigors, unrousable coma, and hepatomegaly. CSF and blood biochemistry were normal. Thick blood films taken on admission were negative for malaria parasites. She died within 2 h of admission before treatment. Post-mortem examination confirmed cerebral malaria. Case 3 Y.B., a 3-year-old, 10-kg girl with fever, cough, convulsions, and coma, was seen decerebrate and PCV of 21 per cent. The admission thick film was negative for P.falciparum, but positive 12 h later. A diagnosis of cerebral malaria was made at this point; she was treated with intravenous chloroquine and recovered fully.
A negative blood film made for diagnosis of severe malaria may be due to extensive vascular cytoadherence of the parasitized red cells.1 Previous reports have demonstrated this in the cerebral vessels of fatal cases, while parasites may be scanty peripherally.1 Synchronicity of infection and previous intake of antimalarials may also temporarily clear the peripheral blood of parasites. Poor techniques whilst making malaria slides may result in false negative slides.2 Therefore, careful examination of several slides at regular intervals (6- or 12-hourly) for parasites and pigments in white cells is advocated when cerebral malaria is suspected and the initial slide negative. O. WALKER, A. SOWUNMI, and L. A. SALAKO
Department of Pharmacology and Therapeutics College of Medicine University of Ibadan Ibadan Nigeria Acknowledgements This study received support from the UNDP/World Bank/WHO fund for Training and Research in Tropical Diseases. References 1. World Health Organization. Severe and complicated malaria. Trans Roy Soc Trop Med Hyg 1990; 84: Suppl 2. 2. Brooks MG, Karet F, Lewis DA, Chid A, Weir WRC. Interpretation of blood films in diagnosis of malaria. Lancet 1989; ii: 619.
Case 5 Y J., a 7-year-old girl (21 kg) presented in coma with a febrile illness. Blood films for malaria parasites on admission were negative. A provisional diagnosis of cerebral malaria was based on the finding of pigments
Sir, Unchecked commercialization of ORS—a road to disaster? WHO ORS was introduced as a single solution for the correction of all types of diarrhoeal dehydration with certain guidelines. However, ORS packets currently available are barely sufficient to provide rehydration therapy for 10 per cent of childhood diarrhoeal dehydration. 1 This has encouraged pharmaceutical companies to step in to meet the demand. However, to make their products unique, companies have started adding other ingredients freely. For increasing saleability, many of these peparations have been sweetened. Manufacturers have also taken the advantage of demand for ORS with different concentration of sodium. 2 The increase in cost and unawareness about
268
Journal of Tropical Pediatrics
Case 4 A.S., a 10-kg, 1-year-old girl seen with fever, convulsions, and unrousable coma. Thick blood films taken on admission after a normal CSF was negative for malaria parasites. Malaria pigments were found in the white cells. A provisional diagnosis of cerebral malaria was made and she was started on intravenous quinine. A 24-h blood film revealed numerous P. falciparum parasites. She therefore continued on quinine and recovered completely.
© Oxford University Press 1992
Vol.38
October 1992
Downloaded from http://tropej.oxfordjournals.org/ at University of Victoria on July 12, 2015
Case 1 R.A., a 24-kg, 9-year-old boy with a 3-h history of unrousable coma following a febrile illness was referred. Examination showed pallor, spasticity, and coma. A diagnostic blood film was negative for malaria parasites. His haematocrit (PCV) was 29 per cent; the cerebrospinal fluid (CSF) was normal. He was managed as viral encephalitis. He died within 12 h of admission. Post-mortem examination confirmed cerebral malaria.
in the white cells, and the patient was started on intravenous quinine. Twenty-four-hour blood films, revealed P.falciparum. She also recovered fully.
