Severe Falciparum Malaria08 / 18
Four hours later.
0200 — Admission
GCS 13 · BP 84/48 · Temp 39.8° · Parasitaemia 7%. IV artesunate commenced. ICU admission.
0400 — +2 h
GCS 10 · increasing agitation. Noradrenaline 0.05 mcg/kg/min commenced.
0600 — +4 h
GCS falls to 8 · generalised seizure × 1. BP 78/40. Noradrenaline escalated.
0800 — +6 h
Intubated · ventilated · bilateral CXR infiltrates. FiO₂ 0.70 · PEEP 12 · P/F 110.
Cerebral malaria — pathophysiologyP. falciparum in RBCs
↓ Cytoadherence via PfEMP1
↓ Endothelial activation (ICAM-1)
↓ Microvascular obstruction
↓ Brain oedema + coma
Key teachingSteroids are contraindicated in cerebral malaria — the SNAP trial showed increased coma duration and GI complications.
CICM Fellowship Masterclass · 2026Dr Timothy Chimunda FCICM