Cerebral malaria is caused by?

Appeared in: NCL (MP) Nursing Officer - 2020

Explanation

Cerebral malaria is a severe, life-threatening complication primarily caused by Plasmodium falciparum.
This species modifies infected red blood cells, causing them to adhere to the endothelium of cerebral microvasculature (a process called cytoadherence or sequestration).
This blockage reduces blood flow, leading to cerebral hypoxia, edema, and inflammation, which results in symptoms like impaired consciousness, seizures, and coma.
Due to its ability to infect red blood cells of all ages, P. falciparum can achieve very high parasite densities, contributing to its severe pathogenicity.

Option A: Plasmodium vivax typically causes a less severe form of malaria known as benign tertian malaria. While severe complications can occur, it is not the primary causative agent of cerebral malaria.
Option C: Plasmodium malariae causes a chronic, low-grade infection with a 72-hour fever cycle (quartan malaria). It is not associated with cerebral malaria.
Option D: Plasmodium ovale is similar to P. vivax, causing a relatively mild tertian malaria that can also relapse from dormant liver stages. It is an uncommon cause of malaria and is not associated with cerebral complications.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology of Cerebral Malaria as background academic context rather than a clinical decision trigger.
Recognizing that P. falciparum causes cerebral malaria is critical for nurses, as it signals a medical emergency requiring immediate intervention.
Key signs of severe malaria include altered consciousness (Glasgow Coma Scale score below 11), multiple seizures, severe anemia, and hypoglycemia. Prompt assessment and reporting are vital.
The priority treatment for severe falciparum malaria is intravenous (IV) artesunate. Nurses must be prepared to administer this medication rapidly as per protocol to prevent death and disability.

How to Approach the Question

First, identify the key term in the question: 'Cerebral malaria'. Recognize this as the most severe neurological complication of the disease.
Second, recall the different species of Plasmodium that cause malaria in humans.
Third, differentiate the species based on the severity of the disease they typically cause. Associate the most severe form of malaria with a specific species.
Finally, select the option that is known to be the most virulent and the primary cause of severe complications like cerebral malaria.

Concept Tested & Keywords

QS56kqSDLsphKRVo9-kBKC

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 2177-2179

E6 Medicine Harrison 22e Part 1 p. 1801-1803

Practise the full NCL (MP) Nursing Officer - 2020

Attempt every question from this paper in a timed mock, then review the full solution for each one.