Malaria is a major killer in tropical countries. In Africa, half a million people died from malaria in 2013. Most of them were children. Researchers have learned that swelling of the brain is often the way malaria kills children infected with a severe form of the disease. This information may help create better treatments for the disease.
Cerebral malaria is a malaria infection of the brain and is an extremely deadly form of the disease. This type of malaria kills 15% to 25% of children who contract it. It often leads to coma and death, and survivors may be left deaf, blind, or with developmental disabilities.
There had been evidence that one reason for the high mortality rate was increased volume due to swelling in the brain. This swelling causes increased pressure within the skull. To test this idea, researchers from Malawi, Great Britain, and the United States performed magnetic resonance imaging (MRI) scans on children in Africa who had been admitted to the hospital and diagnosed with cerebral malaria. The children were scanned on the day they were admitted and then daily while they were still in a coma. Out of 168 children enrolled in the study, 25 died.
Of the 25 children who died, 21 (84%) showed signed of severe brain swelling on the MRI scans. Severe brain swelling was seen in only 39 (27%) of the children who survived.
The MRIs also showed that the brain volume decreased in the survivors who had brain swelling when they were admitted.
Increased pressure in the skull can cause parts of the brain to stop functioning, including the parts of the brain and brain stem that control breathing. It is possible to help save children who stop breathing due to brain swelling with ventilators, but these are not widely available in Africa. Drugs such as corticosteroids may also be able to reduce brain swelling, but such treatments would have to be researched.
The study was published in the New England Journal of Medicine.