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Letters to the Editor
5 (
3
); 320-320
doi:
10.4103/0976-3147.133657

Life threatening intracranial hemorrhages in malaria

Address for correspondence: Dr. Khichar Shubhakaran, House No. - 22/9, Umaid Hospital Campus, Jodhpur - 342 001, Rajasthan, India. E-mail: drkhicharsk@gmail.com
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher; therefore Scientific Scholar has no control over the quality or content of this article.

Sir,

The article entitled “Extradural hematoma in plasmodium vivax malaria; Are we alert to detect?”, published in August 2013 online issue of our esteemed journal JNRP (Vol 4. issue 5, page 145-146), is an excellent documentation. In the same issue the commentary by S J Khan has further elaborated the condition. Here I would like to share my views which would further enlighten the condition.

  • Malaria causes various hematological and hemorrhagic complications with thrombocytopenia, among which the ocular and the intracranial hemorrhagic complications are rare but are more so fatal compared to general bleeding complications

  • If intracranial or subdural/extradural hematomas are not recognized and treated promptly with correction of associated hematological complications and evacuation of hematoma, it may be potentially fatal

  • Vitreous hemorrhage may be an important cause of visual impairment in malaria patient besides cortical blindness and optic neuritis[1]

  • In India, in the malaria post-resurgent era, the complications are not likely to occur as early as it used to occur in early 1990's outbreaks but, quite late after about an interval of a week or two, as it happened in this case, if the patient is not treated promptly in the initial stage. These complications are documented/observed in case of jaundice/hepatitis and renal failure as is the condition in the present case

  • Thrombocytopenia is also a feature of severe malaria and most of the times decreased platelets counts are also associated with abnormal function. A correlation with severity of malaria with thrombocytopenia has also been described[23]

  • The view expressed in the commentary that plasmodium vivax malaria may not be benign malaria was argued by Picot in 2006[4] is good but a landmark study in this subject was also documented by Kochar et al., in the same year[5]

  • So there is a need of the hour to treat each and every patient of malaria at the onset of fever/first symptoms so as to avoid such complications.

References

  1. , , , , . Vitreous hemorrhage in falciparum malaria. J Assoc Physicians India. 1997;45:670.
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  2. , , , , , , . The changing spectrum of severe falciparum malaria: A clinical study from Bikaner (Northwest India) J Vector Borne Dis. 2006;43:104-8.
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  3. , , . Malarial Hepatitis. J Assoc Physicians India. 2005;53:653.
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  4. , . Is Plasmodium vivax still a paradigm for uncomplicated malaria? Med Mal Infect. 2006;36:406-13.
    [Google Scholar]
  5. , , , , , , . Plasmodium vivax malaria. Emerg Infect Dis. 2005;11:132-4.
    [Google Scholar]

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