Singh Veer Bahadur, Kumar Harish, Meena Babu Lal, Chandra Subhash, Agrawal Jatin, Kanogiya Naresh
Senior Professor, Department of Medicine, SP Medical College , Bikaner, Rajasthan, India .
Senior Resident, Department of Medicine, SP Medical College , Bikaner, Rajasthan, India .
J Clin Diagn Res. 2016 Jul;10(7):OC24-8. doi: 10.7860/JCDR/2016/19035.8169. Epub 2016 Jul 1.
Malaria is the most important parasitic disease of humans causes clinical illness over 300-500 million people globally and over one million death every year globally. The involvement of the nervous system in malaria is studied in this paper, to help formulate a strategy for better malaria management.
To study the Neuropsychiatric manifestation in malaria.
This was a prospective observational study in 170 patients with a clinical diagnosis of malaria admitted in various medical wards of medicine department of PBM Hospital, Bikaner during epidemic of malaria. It included both sexes of all age groups except the paediatric range. The diagnosis of malaria was confirmed by examination of thick and thin smear/optimal test/strip test. Only those cases that had asexual form of parasite of malaria in the blood by smear examination or optimal test were included in the study.
Out of total 170 patients 104 (62%) reported Plasmodium falciparum (PF), Plasmodium vivax (PV) were 57 (33.5%) followed by mixed (PF+PV) 9 (5.3%) cases. The total PBF-MP test positivity was 84.5%. Maximum patients were belonging to the age range of 21-40 year with male predominance. Neuropsychiatric manifestation seen in falciparum malaria (n=111) as follow: altered consciousness 20 (18.01%), headache 17 (15.32%), neck rigidity 5 (4.5%), convulsion 5 (4.55%), extra pyramidal rigidity 2 (1.8%), decorticate rigidity 1 (0.90%), decerebrate rigidity 1 (0.90%), cerebellar ataxia 3 (2.7%), subarachnoid haemorrhage 1 (0.90%), aphasia 2 (1.8%), subconjunctival haemorrhage 1 (0.90%), conjugate deviation of eye 1 (0.90%) and psychosis 6 (5.40%). Twenty one patients presented with cerebral malaria out of 111 patients. Most patients of cerebral malaria presented with altered level of consciousness followed by headache and psychosis. Acute confusional state with clouding of consciousness was the most common presentation of psychosis (50%).
Neuropsychiatric manifestations are not an uncommon presentation of malaria. Most commonly caused by PF malaria. Malaria should be thought as a differential diagnosis in pyrexia with neuropsychiatric manifestation. Observation obtained in the study will be highly useful for the diagnosis and management of patients suffering from malaria.
疟疾是人类最重要的寄生虫病，全球每年有3亿至5亿人出现临床症状，每年导致全球超过100万人死亡。本文对疟疾累及神经系统进行了研究，以帮助制定更好的疟疾管理策略。
研究疟疾的神经精神表现。
这是一项前瞻性观察性研究，研究对象为170例临床诊断为疟疾的患者，这些患者在比卡内尔PBM医院内科各病房住院，处于疟疾流行期。研究对象包括各年龄组的所有性别，但不包括儿童。通过厚涂片和薄涂片检查/最佳检测/试纸检测确诊疟疾。只有那些通过涂片检查或最佳检测发现血液中有疟原虫无性体的病例才纳入研究。
在170例患者中，104例（62%）报告为恶性疟原虫（PF），间日疟原虫（PV）为57例（33.5%），混合感染（PF+PV）9例（5.3%）。PBF-MP检测总阳性率为84.5%。大多数患者年龄在21至40岁之间，以男性为主。恶性疟（n=111）的神经精神表现如下：意识改变20例（18.01%）、头痛17例（15.32%）、颈部强直5例（4.5%）、惊厥5例（4.55%）、锥体外系强直2例（1.8%）、去皮层强直1例（0.90%）、去大脑强直1例（0.90%）、小脑共济失调3例（2.7%）、蛛网膜下腔出血1例（0.90%）、失语2例（1.8%）、结膜下出血1例（0.90%）、眼球共轭偏斜1例（0.90%）和精神病6例（5.40%）。111例患者中有21例出现脑型疟疾。大多数脑型疟疾患者表现为意识水平改变，其次是头痛和精神病。急性意识模糊状态伴意识混浊是精神病最常见的表现（50%）。
神经精神表现并非疟疾的罕见表现。最常见的是由PF疟疾引起。在伴有神经精神表现的发热患者中，应将疟疾视为鉴别诊断之一。本研究所得观察结果对疟疾患者的诊断和管理将非常有用。
