Gangrene and neurological complications of malaria.

1. Chen QY, Lan Ms, she JX, Maclaren NK. the gene responsible for autoimmune polyglandular syndrome type 1 maps to chromosome 21q22.3 in us patients. J Autoimmun 1998;11:177-183. 2. Halonen M, Eskelin P, Myhre Ag, et al. AIRE mutation and human leukocyte antigen genotypes as determinants of the autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy phenotype. J Clin Endocrinol Metab 1997;87:2568-74. 3. Doniach D, Bottazzo GF. Polyendocrine autoimmunity In: Franklin EC, editor. Clinical Immunology update. Amsterdam: Elsevier North Holland 1981; 95-121. ML Patel*, Rekha Sachan**, MR Patil***, A Mishra**** *Assistant Professor, Department of Medicine, **Associate Professor, Department of Obstetrics and gynaecology, ***Junior Resident, ****Professor and Incharge of Endogoitre unit, Department of Medicne, CsM Medical University, (King George Medical University), Lucknow, Uttar Pradesh Received: 30.06.2011; Revised: 01.08.2011; Re-revised: 26.09.2011; Accepted: 02.10.2011 Gangrene and Neurological Complications of Malaria sir, W read the interesting case report entitled symmetrical peripheral gangrene and neurological manifestations in plasmodium falciparum malaria” by Kotokey and Kaushik published in July 2011 issue of JAPI (vol. 59, page no. 449-451). the article is worth documentation and there are only few case reports earlier mainly from Indian subcontinent/southeast Asia. 1. Neurological manifestations in malaria without loss of consciousness as a presenting illness besides sequelae in survivors of cerebral malaria and delayed complications as post malaria neurological syndrome (PMNs) are documented earlier from India in quite a large number. these were mainly convulsions, psychosis, extra pyramidal rigidity, and ataxia, either alone or in varying combinations. All such patients had complete recovery with appropriate antimalarial treatment in due course of time.1 Of course not all such cases are being categorized as severe and complicated malaria as per WHO (World health organization) but should be treated on the line WHO guidelines meant for severe and complicated malaria.1 2. Computed tomography of the reported patient showed atrophy. It would have been worthwhile if the authors had got done the Magnetic resonance imaging which probably could have defined the site of lesion for coticospinal signs to some extent. Furthermore it was not clear that the atrophy was sequelae of malaria or there was some other alternative cause for that. 3. the authors used 5% dextrose for quinine infusion, but 10% dextrose would have been a better option as per our experience.2 4. Last but not least quotation of reference is also of utmost importance for any article and the authors need to review the quotation of reference number two.