It is already cold in Palamu. Nights are quite cold enough to warrant the use of quilts. But, the climate is quite unusual for malaria. Maybe, after all the posts against malaria, the malarial parasite and the mosquitoes are getting back at me. There have enough reasons for me to suspect things other than malaria.. There was a well documented case where I was sure that it was imported leptospirosis from Kerala. There has already been an epidemic of viral encephalitis in the neighbouring districts. Of course fevers in NJH has always been baffling me and I still strongly believe that we have more causative agents other than just malaria or typhoid.
Coming back to malaria we’ve already had about 5 cases of Plasmodium Falciparum and another 4 cases of Flasmodium Vivax over the last week. However, yesterday, I had 2 little children who came in with confirmed blood smears of Plasmodium Falciparum. Read their stories.
The first to come in was PS who came in late in the morning. The history was very peculiar. PS was doing quite well in the morning and was playing with his friends, when he suddenly collapsed and became unconscious. The history initially looked like he had a head injury. On examination, DK was quite stuporous, crying incessantly and quite significantly appeared to be hemiplegic on the right side of the body. The right side of the body was in a state of spasm with flexion of both the upper limb and lower limb.
All the possible causes of a young stroke raced through my mind. But the blood tests brought about a surprise. He had falciparum teeming in his blood and he started to run a very high grade fever. Since there was a hemiplegia involved, I started to condition the parents to take the patient to Ranchi for a CT scan. But, the family was very poor.
I started him on the classical treatment for Cerebral Malaria. I was surprised when I saw him in the night. His hemiplegia was resolved and he was crying for food.
However, the next patient was not very lucky. SB, a 5 year old boy from one of the nearby villages was visiting relatives elsewhere where he had fallen sick since the last 5 days. One of the village quacks were providing treatment. Today early morning he had become unconscious. The parents realized the gravity of the situation and rushed him to his home village nearby.
Unfortunately, the first place they went to was again one of the local quacks. By nightfall, they realized that SB was quite sick. SB came to NJH at around midnight. On examination, it was obvious that SB was quite sick and only a miracle could save him. The blood investigations only confirmed the inevitable. Hemoglobin was a pathetic 5 gm% and 75% of his Red Blood Cells contained the falciparum parasite. His platelet count was 17,000/cu mm.
The parents wanted to know if taking to Ranchi would be of any benefit. I told them of the pros and cons. Ultimately, they took the decision to take to Ranchi. I wrote off the referral letter. However, I started to harangue them for some blood to transfuse. But, the response from the parents was very cold.
The labour room was also quite busy. I was busy attending to other patients too. Somewhere in my mind I lost track of the child considering into fact that the parents have already taken the option of referral. Unfortunately, what I did not realize was that the parents were waiting till daybreak before they took SB to Ranchi.
The next thing I know is Dr Nandamani informing me at 7:30 next day morning that SB died. There was nothing we could do. Later I realized that I had written the chart for SB and the treatment was started.
Maybe if had some blood, SB would have survived. But again with a platelet count of 17,000, I’m not very sure.
SB could have been saved had we got a blood smear done and started him on Chloroquine quite early. PS’s presentation still perplexes me. I saw him today morning. He has improved quite a lot.
SB could have been saved had we got a blood smear done and started him on Chloroquine quite early. PS’s presentation still perplexes me. I saw him today morning. He has improved quite a lot.
Ultimately, whatever said about newer emerging and newer emerging diseases, malaria continues remain as a scourge in the public health scenario of places such as ours.
