Cerebral malaria: insight into pathogenesis, complications and molecular biomarkers

Cerebral malaria: insight into pathogenesis, complications and molecular biomarkers Farah Hafiz Yusuf,1 Muhammad Yusuf Hafiz,1 Maria Shoaib,1 Syed Ahsanuddin Ahmed2 1Department of Medicine, Dow Medical College, Dow University of Health Sciences, 2Department of Medicine, Sindh Medical College, Jinnah Sindh Medical University, Karachi, Pakistan Abstract: Cerebral malaria is a medical emergency. All patients with Plasmodium falciparum malaria with neurologic manifestations of any degree should be urgently treated as cases of cerebral malaria. Pathogenesis of cerebral malaria is due to damaged vascular endothelium by parasite sequestration, inflammatory cytokine production and vascular leakage, which result in brain hypoxia, as indicated by increased lactate and alanine concentrations. The levels of the biomarkers’ histidine-rich protein II, angiopoietin-Tie-2 system and plasma osteoprotegrin serve as diagnostic and prognostic markers. Brain imaging may show neuropathology around the caudate and putamen. Mortality is high and patients who survive sustain brain injury which manifests as long-term neurocognitive impairments. Keywords: cerebral malaria, neurologic manifestations, mortality, biomarkers, brain imaging