Images in Clinical Tropical Medicine Confirming Cerebral Malaria Deaths in Resource-Limited Settings

A 4-year-old Papua New Guinean girl presented with unre-sponsive coma (Blantyre coma score = 2) after a short febrileillness. She did not have neck stiffness, a positive Kernig’ssign, or other clinical features of bacterial meningitis. Micros-copy confirmed a peripheral blood Plasmodium falciparumasexual parasite density of 33,960/mL. Despite parenteralartemether and intensive supportive therapy, she diedwithin 6 hours of admission. Supraorbital post-mortem brainbiopsy revealed P. falciparum in the cerebral microvascula-ture (Figures 1 and 2).As part of renewed global efforts to eradicate malaria, theWorld Health Organization has recently emphasized the needfor improved surveillance and case management, includingaccurate documentation of malaria-related deaths.