Malaria is an infectious disease caused by a parasite spread by mosquitoes and a major killer in the tropics. There is no vaccine. Medicine can prevent the infection and treat malaria, but it can still be fatal particularly in young children even with treatment.
Cerebral malaria is an extremely risky form of the disease that can lead to coma and death, its lethality has largely been a mystery — until now.
Cerebral malaria patients are known to die because they stop breathing, due to accumulated fluid in the lungs. Doctors suspected that brain swelling had a big part in terminal cases, but the proof was not clear.
According to Dr. Terrie E. Taylor of Michigan State University, most researchers thought the inflamed brain pushed the skull to the bottom, squeezing the brain stem.
“And that’s where the respiratory center is,” she said. “So once that respiratory center is pressed upon, the actual neural impulse to take a breath is quashed.”
But an extensive autopsy study of cerebral malaria victims was inconclusive.
“We didn’t see the kind of classic ‘textbook features’ that we were expecting to see.”
Hoping to resolve the issue, Taylor thought the answer might be found in MRI brain scans of living patients, instead of looking at brains in an autopsy,. But in that time Malawi did not have an MRI machine, where Taylor spends about half of each year, .
So in 2008, Queen Elizabeth Hospital in Blantyre received MRI machine as donation of General Electric. Taylor says with the scanner her team can monitor patients and also evaluate those who survived with those who did not. Researchers performed MRI scans on children whose illness met a strict definition of cerebral malaria.
“Nearly all those who died all had increased brain swelling, and the survivors had a much smaller incidence of brain swelling,” she said.
With the findings on how cerebral malaria victims die, Taylor says the next step is to try to detect what is causing the brain to swell, so perhaps it can be reversed.
At the same time, she wants to make out if putting patients on a ventilator to support their breathing for a few days might allow them to survive until the brain swelling subsides.