Bacterial Meningitis w/ Cerebral Malaria

A female aged 50 yrs presented with complains of intermittemt High grade fever and irritable behavior since 20 days and on examination was found to have Mild Neck rigidity and altered mentation. Was started on I/V ceftriaxone and steroids and MRI brain was done which came out to be normal. No h/o DM/HTN/ATT intake or TB/ LOC/Seizures etc. CSF done and report awaited....Probable cause and line of management!!@Dr. Umesh Patnaik @Dr. Shailesh Bamborde @Dr. Gupta Harbilass @Dr. Manish Doshi

Malaria is a disease having symptoms of recurrent fever with chill and headache. After onset of fever it subsides after sometimes and again reoccurs. In severe cases it can progress to coma or even death. It is caused by parasites known as Plasmodium. It commences with the bite of female Anopheles mosquitoes which carries this parasite. The disease is widespread in tropical and subtropical regions around the equator, including much of Sub-Saharan Africa and Asia. In India the disease occurs throughout the year across the country. However, it is more prevalent during and after the rainy season due to mosquito breeding. According to World Health Organization (WHO), India contributes 77% of the total malaria cases in Southeast Asia. The disease is mainly prevalent in the states of Rajasthan, Gujarat, Karnataka, Goa, Southern Madhya Pradesh, Chhattisgarh, Jharkhand, Odisha and in northeastern states. Symptoms of malaria can develop in seven days after the bite from the infected mosquito. Typical symptoms include: Fever, headache, vomiting and other flu-like symptoms, (The fever occurs in four-to-eight hour cycles.) The parasite infects and destroys red blood cells resulting in fatigue, fits/convulsions and loss of consciousness. If the symptoms of malaria are not identified on time, the result can be fatal. Malaria parasites belong to the genus Plasmodium. In humans, malaria is caused by P. falciparum, P. malariae, P. ovale, P. vivax. The life cycle of parasite completes in mosquitoes and human. DISEASE PROCESS: Malaria is caused by parasites known as Plasmodium This parasite is generally spread by female Anopheles mosquitoes, known as night-biting mosquitoes, as it generally bites between dusk and dawn. If a mosquito bites a person infected with malaria, it can also become infected and spread the parasite on to others. During the bite of female mosquitoes, the half matured parasite transmits from the saliva of the mosquitoes into the small blood vessels (circulatory system) of the human through a special body part of the mosquitoes called as Proboscis. The parasite enters the bloodstream and travels to the liver. In the blood, the parasites travel to the liver cell and there they mature and reproduce. The infection develops in the liver before re-entering the bloodstream and invading the red blood cells. The parasites grow and multiply in the red blood cells. At regular intervals, the infected blood cells burst, releasing more parasites into the blood. Infected blood cells usually burst every 48 to 72 hours. Each time they burst, one will have a bout of fever, chills and sweating. Man develops disease after 10 to 14 days (incubation period) of being bitten by an infective mosquito. Uninfected female Anopheles if bite does not cause Malaria. Malaria can be diagnosed by the doctor based on the patient’s history (fever with chill and rigor) followed by the clinical assessment (enlargement of liver and spleen). Microscopic examination: The most preferred and reliable diagnosis of malaria is microscopic examination of blood films as all of the four major parasite species can be distinguished easily. Immuno chromatographic test: This is also called as Malaria Rapid Diagnostic Test. This test uses finger-stick and a drop of venous blood. The reading can be assessed visually as the presence of colored strips on the dipstick. It takes a total of 15–20 minutes to complete the procedure. Molecular methods: Molecular methods are available such as polymerase chain reaction (PCR). It is more accurate than microscopy. The treatment chosen will depend upon whether the patient has vivax malaria or falciparum malaria as diagnosed by the blood test, age of the patient, the pregnancy status of the female patient and location of the patient. Malaria is a very serious illness which can be fatal if not diagnosed and treated in time. The falciparum parasite causes the most severe form of malaria which can be fatal. The complications related to malaria are as follows: Anemia: The destruction of red blood cells by the malaria parasite can cause severe anemia. Anemia is a condition where the red blood cells are unable to carry enough oxygen to the body's muscles and organs, leaving the patient with the feeling of being drowsy, weak or faint. Cerebral malaria: Cerebral malaria occurs due to affects in the brain and causes brain to swell, sometimes leading to permanent brain damage. It can also cause seizures (fits) or coma (a state of unconsciousness). Pregnancy and malaria Pregnant women have increased risk of developing complications. The World Health Organization (WHO) recommends that pregnant women should avoid travelling to areas where there is a risk of malaria. Malaria in pregnancy poses a substantial risk to the mother, the fetus and the newborn infant. Pregnant women are less capable of coping with malaria infections, which may adversely affect the fetus. Other complications Other complications that can arise due to severe malaria include: Breathing problems, such as fluid in the lungs Liver failure and jaundice (yellowing of the skin and whites of the eyes) Shock (a sudden drop in blood flow) Spontaneous bleeding Abnormally low blood sugar Kidney failure Swelling and rupturing of the spleen Dehydration (a lack of water in the body) Prevention of malaria solely depends upon the prevention from mosquitoes bite. The following are the effective preventive measures: (A) Control Insect Breeding (Larval and Pupa Stage) All breeding places should be filled and covered. Avoid storage of water in tyres, pots, coolers and tanks. Regular cleaning (weekly) of such articles is important to prevent mosquito breeding. Use of larvivorous fish like gambusia or guppy in ornamental tanks, fountains and other places. Use of chemical pesticides like Abate in potable water. (B) Individual Preventions Use an intact mosquito net while sleeping. Use mosquito repellent creams, liquids, coils and mats. Use Indoor Residual Spray (IRS) with insecticides. Use Aerosol space spray during day time. Use biocides. Get houses fitted with wire mesh. Use bed nets treated with insecticide Cover your body properly. (C) Prevention in Community Malathion fogging during outbreaks. The place around the Hand Pump should be properly cemented, along with drainage system. Sensitizing and mobilizing the community to eradicate Anopheles breeding sites. (D) Prevention during Travel Before planning your travel, find out the malaria risk in that area and take the advice from doctor before visiting that area. (E) Prevention of Malaria during Pregnancy Use of treated nets/LLINs (Long Lasting Insecticidal Nets). Take all personal preventive measures as mentioned above. Source : NHP

A young female aged 20 yrs presented with history of Fever high grade, Agitation and Headache since 3 days f/b Altered Sensorium since 2 days...No history of any comorbidity or any drug intake is present....Discuss the differential n treatment approach to this pt ...

patient present with vomiting fever one month, lumbar puncture safe in this patient or not

RECURRENT MENINGITIS WITH ENCEPHALOCELE WITH CSF RHINORRHOEA