Uddin Syed Mohammad Mazhar, Haq Aatera, Haq Zara, Yaqoob Uzair, Shah Haider, Kazmi Syed Faheem Ali
Medicine, Civil Hospital Karachi, Karachi, Karachi, PAK.
Medicine, Civil Hospital Karachi, Karachi, PAK.
Cureus. 2018 May 2;10(5):e2569. doi: 10.7759/cureus.2569.
Cerebral malaria is one of the most common causes of non-traumatic encephalopathy. A 25-year-old man who is a known intravenous and oral drug abuser presented to our clinic with fever and sore throat for two days prior and an altered level of consciousness for one day. On examination, the patient was icteric, and his Glasgow coma scale score on arrival was 10/15; he had dilated pupils reactive to light and a positive corneal reflex. All cranial nerves were intact; however, signs of meningeal irritation were positive. Motor examination showed an increased tone and rigidity in all limbs, patellar reflex was 3+, plantars were down-going, and clonus was negative. A fundoscopic examination was unremarkable. Additional investigations revealed he was positive for Plasmodium falciparum, HIV, hepatitis B, and hepatitis C. In addition, a test of his cerebrospinal fluid revealed evidence of cerebral malaria. We initiated artemether 120 mg, intravenous ceftriaxone 2 g, and 5% dextrose saline for the intermittent hypoglycemia. The patient's condition eventually improved drastically. This case outlines the possible exacerbating effect of HIV on malaria, and it calls for HIV screening and staging alongside suspected malaria. This case also underlines the need for further evaluation of a potential protective role of hepatitis B and C to find an alternative therapeutic cure for malaria.
脑型疟疾是非创伤性脑病最常见的病因之一。一名25岁男性，已知有静脉注射和口服药物滥用史，因前两天发热、咽痛及一天来意识水平改变前来我院就诊。检查时，患者有黄疸，入院时格拉斯哥昏迷量表评分为10/15；瞳孔散大，对光有反应，角膜反射阳性。所有颅神经均完整；然而，脑膜刺激征阳性。运动检查显示四肢肌张力增加和强直，髌反射为3+，足底反射向下，阵挛阴性。眼底检查无异常。进一步检查发现他的恶性疟原虫、艾滋病毒、乙型肝炎和丙型肝炎检测均呈阳性。此外，对其脑脊液的检测显示有脑型疟疾的证据。我们开始使用蒿甲醚120毫克、静脉注射头孢曲松2克以及5%葡萄糖盐水来治疗间歇性低血糖。患者的病情最终大幅好转。该病例概述了艾滋病毒对疟疾可能的加重作用，呼吁在疑似疟疾时同时进行艾滋病毒筛查和分期。该病例还强调需要进一步评估乙型和丙型肝炎的潜在保护作用，以寻找疟疾的替代治疗方法。
