Malaria is a
parasitic disease that is starting to be encountered in intensive care units (ICU) worldwide, owing to increasing globalisation. Severe
malaria caused by Plasmodium falciparum, is characterised by
cerebral malaria,
acute renal failure, hypoglycaemia, severe anaemia,
splenomegaly and alveolar oedema. We present the case of a 25-yr old male patient who presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of
fever for three days. His medical history revealed a 14-month stay in Tanzania. Staining of blood smears revealed characteristic gametocytes in accordance with P. falciparum
infection. The day after admission, he had an epileptic seizure after which his Glasgow Coma Scale was 6, so he was intubated and transferred to the ICU. A computerized tomography scan revealed findings of cerebral oedema. Intravenous
mannitol was administered for 6 days. Intravenous
artemisinin was continued for 10 days. Due to refractory
fevers,
anti-malarial treatment was switched to
quinine and
doxycycline on the 14th day and on the 16th day the
fevers ceased. This case emphasizes that
cerebral malaria should be suspected in cases of
seizures accompanying
malaria, and treatment should be initiated in the ICU. Furthermore, resistance of P. falciparum to
artemisinin should be in mind when a response to
therapy is lacking.