Which statement is NOT CORRECT about cerebral malaria?

RML Lucknow - 2021

Pharmacology

Easy

Appeared in: RML Lucknow - 2021

Explanation

The statement that primaquine is the drug of choice for cerebral malaria is incorrect.
The first-line treatment for severe or complicated malaria, including cerebral malaria, is intravenous (IV) artesunate.
IV artesunate is preferred over quinine because it is associated with lower mortality and acts rapidly to clear the parasites.
Primaquine is an antimalarial drug used for the radical cure of P. vivax and P. ovale infections (to eliminate dormant liver stages) and as a single dose to prevent transmission of P. falciparum, but not for treating the acute severe illness.

Option A: This statement is correct. Cerebral malaria is the most severe neurological complication of an infection with the Plasmodium falciparum parasite.
Option B: This statement is correct. Altered sensorium, ranging from confusion to coma, is a defining clinical feature of cerebral malaria, as indicated by a low Glasgow Coma Score or Blantyre Coma Score.
Option C: This statement is correct. The malaria parasite multiplies within red blood cells, causing them to rupture (haemolysis). In severe falciparum malaria, this leads to significant haemolysis, resulting in severe anemia, jaundice, and haemoglobinuria (dark urine).

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacotherapy and pathophysiology of cerebral malaria as background academic context rather than a clinical decision trigger.
Nurses must be able to differentiate the treatments for severe vs. uncomplicated malaria. Administering the wrong drug, like primaquine for cerebral malaria, can be fatal.
Key nursing actions for a patient with cerebral malaria include meticulous neurological monitoring (GCS), seizure precautions, frequent blood glucose checks (risk of hypoglycemia), and prompt administration of IV artesunate.
Before administering primaquine for any indication, it is critical to check the patient's G6PD (glucose-6-phosphate dehydrogenase) status. Administering primaquine to a G6PD-deficient individual can cause severe, life-threatening haemolysis.

How to Approach the Question

First, identify the negative framing of the question ('NOT CORRECT'). This means three of the options are true statements about cerebral malaria, and one is false.
Second, recall the core facts about cerebral malaria: its cause (P. falciparum), key symptoms (altered sensorium), and pathophysiology (haemolysis).
Third, evaluate each option against this knowledge. Options A, B, and C are well-known characteristics of the disease.
Fourth, specifically analyze the treatment option (D). Recall the first-line drugs for different malaria types. The drug of choice for severe malaria is IV artesunate, not primaquine.
Finally, conclude that the statement about primaquine being the drug of choice is the incorrect one, making it the correct answer to the question.

Concept Tested & Keywords

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) pp. 278-280, 276-278

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 2185-2187