Malaria is a preventable, treatable disease, but it’s far from under control in many parts of the world, including Africa, where it is particularly lethal to children. Much of that toll is the result of malaria infiltrating the brain. But with increased attention and funding, research on malaria is flourishing in some unexpected areas, including understanding the interaction of the brain and the immune system.

Halima, a three-year-old girl, was brought to the hospital in Kenya after running a fever for almost two days.  At first, the fever seemed nothing to be particularly concerned about, so Halima’s mother gave her paracetamol (acetaminophen) to bring down her temperature and left her in the care of an older sister while she went out to work on the farm. But when she returned a few hours later, she was unable to wake her child. She shook her gently and Halima’s eyes opened, but the girl stared blankly ahead, unable to make eye contact.  Her sister told their mother that Halima had had a convulsion earlier, her arms and legs jerking uncontrollably for several minutes before her body went limp. It was then that the mother began the arduous four-hour trek to the hospital for treatment.

The hospital physician noted that Halima’s fever was over 103° Fahrenheit and her gaze was blank and roving.  Shortly after the initial examination, Halima began convulsing again, and the physician administered an anticonvulsant drug.  How does malaria produce such profound symptoms?  Could the body itself be causing damage in its attempts to keep the parasite at bay? The physician listened to her mother’s story—one that physicians hear day after day in Kenya, Malawi, and other parts of sub-Saharan Africa—and made a tentative diagnosis of cerebral malaria, a form of severe malarial infection.  He began presumptive treatment with quinine and intravenous fluids and waited to see if Halima would be one of the lucky ones who manage to survive.

Hundreds of millions of people contract malaria each year, primarily in the poor countries of sub-Saharan Africa.  Most are sick for only a few days. But in a small percentage of those infected, including Halima, the malarial parasites will attach to blood vessels and capillaries in the brain, causing coma, neurological damage, organ failure, and, often, death.

How does malaria produce such profound symptoms?  Could the body itself be causing damage in its attempts to keep the parasite at bay?  What lies behind why some people are stricken with one of the most brutal variations of the disease, while others are not?  Scientists are currently working to answer those questions by studying the malaria parasite itself, the human immune response to this intruder, and the variations in how people experience the disease.  Promising research on cerebral malaria is taking place around the globe, in university laboratories from the United States to Australia and in the field in Africa.