CERBRAL MALARIA

PHYSICIAN DILEMNA, QUININE DIHYDROCHLORIDE VS ARTEMISININ.

Abstract

Cerebral malaria is a disease entity which we commonly come across and that it
should be suspected in every patient with impairment of conscious level and high spiking fever
especially with no history of trauma. Early treatment is crucial and can be lifesaving. There are
two treatment option in which one is conventional Quinine Dihydrochloride and other artmisinin
infusion. Objectives: To study the outcomes of Quinine dihydrochloride and artemisinin
practice in patients with cerebral malaria in terms of acceptance and response. Study Design:
Descriptive cohort study. Place and Duration of Study: Department of Medicine, Unit. II,
Jinnah Postgraduate Medical Centre (JPMC), Karachi from January1st2015 to December 31st,
2015. Methodology: A total of 78 patients fulfilled the inclusion criteria of Glasgow Coma scale
(GCS) were of less than 6 for more than 6 hours Defervescence time were 2 to 3 hours after
start of treatment Strength of our study is that patients traditional prompt response, with coma
multi-organ dysfunction tends to recover and discharge in 4 days. Result: There were total of
78 patient. Out of them 32 (41.0%) were positive for Malaria with 29 (37.1%) were positive for
Plasmodium Falciparum and 3 were having Plasmodium Vivax .all were offered treatment with
57 (73.0%) were given Quinine infusion and 21 (26.94%) were treated with artemisinin infusion.
Cure rate was 44 (56.4%) with 46 (58.9%) in quinine group and 14 (17.9%) artemisinin group and
(19.2%) and 07 (8.9%) respectively making total mortality of 18 (23.0%). There were 9 (11.5%)
patients who left against the medical advice. Average age was 26 ±, majority were male. In
addition laboratory derangements like alanine amino transferases (ALT), bilirubin, creatinine,
electrolytes as potassium and arterial blood gases(ABGs) were also considered. It has been
estimated that recovery time of patients was maximum of 72 hours (time of discharge) for both
artimisinin and Quinine dihydrochloride. Late responders were also observed. Occasionally
persistent of treatment is needed with no fear of drugs resistance. Conclusion: Quinine infusion
is generally safe and effective conventional treatment option, whose benefits and acceptance is
well known and we are also documenting this.