Psychological Disorders Associated with Cerebral Malaria

Student guest post by Laura Vonnahme

As a part of traveling to a developing nation, we are often required to take medical precautions. This generally includes a line-up of shots for various diseases, a few other tests, and various regimens of prophylaxis for possible diseases. I have often left these doctors appointments with a line of band-aids on my arm, a handful of prescriptions and a little weakness in my knees. However, I will readily admit that my malaria prophylaxis is often pushed to the back burner; in fact the last time I went to a developing nation, I didn’t even get the malaria prophylaxis until I was in the country and I didn’t even bother taking it for the prescribed amount of time. However, as I readily admit my shortsightedness in the past, I have become more aware of the chronic conditions that can be caused by a single malaria infection.

Malaria is a mosquito-borne disease caused by a parasite, and there are four different species of parasites that cause malaria, Plasmodium falciparum (which is the most fatal), P. vivax, P. malariae, and P. ovale. When initially infected, parasites first enter the liver, then multiply quickly and enter the bloodstream, where they continue to multiply and rupture blood cells2. While P. falciparum causes the most severe symptoms, P. vivax and P. ovale can cause chronic malaria which is characterized by profound anemia, enlargement of the spleen, emaciation, mental depression, sallow complexion, edema of ankles, feeble digestion, and muscular weakness.

In addition, there is a more serious form of malaria caused by P. falciparum, called cerebral malaria, which can be deadly quickly if left untreated. However, a more controversial disease has been linked to malaria as of late. Recently there have been links to cerebral malaria, posttraumatic stress disorder (PTSD) and other psychological disorders in soldiers who have returned from service in areas where malaria is endemic. In particular several studies have been conducted on soldiers who had contracted malaria while in service during the Vietnam War. Dr. Nils R. Varney conducted one of these first studies here at the University of Iowa and reported that many cerebral malaria survivors from the Vietnam War have a number of neuropsychiatric symptoms that can persist for years after the acute illness has been treated. “Cerebral malaria does a number of different things to a patient’s brain that cause a variety of neurological problems,” Varney says. “…patients who survived the illness frequently developed depression, impaired memory loss, personality change and proneness to violence as long-term effects of the disease. These are symptoms that have been reported by many Vietnam veterans for years and are often treated strictly as PTSD.”

The journal article compared the neuropsychiatric status of 40 Vietnam combat veterans who contracted cerebral malaria between 1966-1969 with 40 Vietnam veterans with similar wartime experience who suffered gunshot or shrapnel wounds during the same period. The participants underwent numerous tests for sensory, cognitive and behavioral symptoms. Findings indicate that cerebral malaria results in multiple, major, substantially underappreciated neuropsychiatric symptoms in Vietnam veterans, including poor dichotic listening, “personality change,” depression, and, in some cases, partial seizure-like symptoms. Findings strongly suggest that history of malaria should be considered in any medical, psychological, or psychiatric workup of a Vietnam War veteran because a positive response could result in substantial changes in diagnosis and treatment. Interestingly, these results seen in Vietnam veterans are similar to those seen in British troops stationed in India during in the 19th century during the height of the British Empire. Nineteenth-century physicians documented these cases and considered malaria a leading cause of mental illness in British-occupied regions

Therefore, continued prophylaxis is extremely important for anyone traveling to an area where malaria is thought to be endemic. Thus, while you may think prophylaxis is a nuisance, the pills make you have weird dreams, you cant remember to take the pill every week or you just plain think your invincible, none of these are valid excuses for skipping a necessary malaria prophylaxis.

References

1. CDC – Malaria. (n.d.). Centers for Disease Control and Prevention. Retrieved April 11, 2010, from http://www.cdc.gov/malaria/

2. Malaria. (n.d.). Penn State Hershey. Retrieved April 11, 2010, from http://www.hmc.psu.edu/healthinfo/m/malaria.htm

3. UI/VAMC study says patient’s history of malaria may be a clue to many Vietnam vets’ psychological and other health problems. (n.d.). Retrieved April 11, 2010, from http://www.newswise.com/articles/uivamc-study-says-patients-history-of-malaria-may-be-a-clue-to-many-vietnam-vets-psychological-and-other-health-problems

4. Varney, N., Roberts, R., & Springer, J. (1997). Neuropsychiatric Sequelae of Cerebral Malaria in Vietnam Veterans. The Journal of Nervous & Mental Disease, 185(11), 695-703. Retrieved April 11, 2010, from http://journals.lww.com/jonmd/Abstract/1997/11000/Neuropsychiatric_Sequelae_of_Cerebral_Malaria_in.8.aspx