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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pulmonary involvement occurs in 3 to 10% of the cases of Plasmodium falciparum malaria and represents the most serious complication of this infection, with a lethality of about 70%. The understanding of its pathogenesis is still very fragmentary, however it is recognized that activation of the immune system by antigens released by the parasite plays an important role in the induction and worsening of lung damage. Capillary endothelial cells, which control the flux of fluids to the interstitial space, appear to be the most involved structure. These cells are activated by cytokines, produced by lymphocytes and macrophages during the immune response, and express receptors and molecules of adhesion, allowing for sequestration of parasitized erythrocytes and adherence of cells, which will produce locally inflammatory mediators. The inflammatory reaction and lesion of endothelial cells that ensue, together with the hemodynamic alterations induced by the capillary blockade due to the sequestration of parasitized erythrocytes and leukocytes, cause alterations of the vascular permeability and transfer of liquid to intertitial space and alveoles. Severe cases are clinically expressed by a picture of Adult Respiratory Distress Syndrome. The clinical manifestations of pulmonary involvement may start suddenly at any time during the course of malaria, even after disappearance of circulating parasites. The inducing factors are unknown. Hyperparasitemia, renal failure and pregnancy are predisposing factors. The prognosis will depend on how fast the diagnosis is established and convenient treatment initiated. If parasites are present they shall be treated with schizonticidal drugs, hemodynamic parameters continuously evaluated, preferably through a Swam-Ganz catheter. Appropriate oxygen supply and fluid balance have to be warranted. Other complications of malaria, frequently associated to the pulmonary involvement, need special attention and proper treatment. A better understanding of the pathogenesis of lung damage associated to malaria will certainly help to improve treatment and reduce morbidity and mortality.
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PMID:[Pulmonary involvement in malaria (review)]. 827 49

A 32-year-old woman in the 26th week of pregnancy became ill, 6 days after returning from a trip to Indonesia, with a fever up to 42 degrees C, haemolytic anaemia (haemoglobin 7.6 g/dl) and thrombocytopenia (7,000/microliters). She had not been on any malaria prophylaxis. Chloroquine, quinine and pyrimethamine, administered after macrogametocytes of Plasmodium falciparum had been found in the blood smear, eliminated the parasites from the peripheral blood, but respiratory failure and treatment-resistant pneumonia occurred, leading to the adult respiratory distress syndrome (Morel stage 4). Because of threatened intrauterine death (resulting from premature placental separation during artificial ventilation) the child was delivered by an emergency section. Despite extensive conventional therapeutic measures the mother's respiratory state progressively deteriorated so that extracorporeal membrane CO2 elimination was instituted on the 17th day. First signs of improvement in respiratory functions were noted after six days. The extracorporeal CO2 elimination was discontinued after twelve days, because artificial ventilation could now be adequately controlled. The woman was gradually weaned from the ventilator and discharged home without symptoms after a total of 11 weeks in hospital. Her child has not shown any neurological symptoms.
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PMID:[Acute respiratory failure in tropical malaria during pregnancy. Successful treatment using extracorporeal CO2 elimination]. 818 19

Resurgence of malaria has been noted in the Rohtak district (Haryana, India) after the recent floods. The profile of 66 patients of P. falciparum infection who were admitted to our hospital over one month in October 1995 is reported. While only a minority of cases (< 15%) presented with an uncomplicated course, all others developed one or more complication(s), some of them very rare. The usual manifestations viz, cerebral malaria, black water fever and algid malaria seen in the past were observed in less than half the patients. The remaining presented with unusual complications like haemolytic anaemia (46.2%), severe anaemia (37.9%), thrombocytopaenia (18.2%), pancytopaenia (6%), adult respiratory distress syndrome (4.5%) often not seen in sporadic cases of falciparum malaria which occurred in the past in this district. Similarly all deaths (15.1%) were noted in patients with rarer manifestations and only one patient died of cerebral malaria. This study confirms the occurrence of severe and complicated falciparum malaria in this part of the country.
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PMID:The changing profile of Plasmodium falciparum malaria. 902 31

Management of severe malaria is an increasing problem worldwide. This paper reviews the pathophysiology and management documenting two years' experience of admissions of severe malaria to an ICU in a non-endemic area. Clinical and laboratory features of severe malaria were analysed for predictors of mortality Twenty-eight patients had clinical or laboratory features compatible with the WHO criteria for severe malaria and, despite treatment with intravenous quinine and supportive ICU care, mortality was 28.5% (8/28). The three pregnant patients died with 100% foetal mortality and the four paediatric patients survived. Of the non-survivors, 8/8 developed ARDS (defined by worst ALI score > 2.5), 7/8 developed shock requiring inotropic support and 7/8 developed acute renal failure requiring CVVHD. Admission haemoglobin, platelet count, parasite count, and lowest Glasgow Coma Score in the first 24 hours were shown not to be predictors of mortality.
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PMID:Predictors of mortality in severe malaria: a two year experience in a non-endemic area. 913 96

Adult respiratory distress syndrome (ARDS) has been a well recognized severe form of acute respiratory failure of multiple causes, which is characterized by intractable hypoxemia and an extremely high mortality rate. Forty-six cases of ARDS admitted to the Department of Medicine, Ramathibodi Hospital during a 39 months period were studied prospectively to explore the etiologic risk, positive end-expiratory pressure (PEEP) profiles, complications and outcome of treatment. There were 19 females and 27 males with the mean age of 40 years. Risks of ARDS included intra- and extra-pulmonary disease conditions and also tropical diseases such as malaria and leptospirosis. At the time of diagnosis, patients in this group were extremely hypoxic with a mean arterial/alveolar oxygen tension (PaO2/PAO2) of 0.125 +/- 0.04. After the application of appropriate PEEP, the mean PaO2/PAO2 ratios increased significantly in both survivor and non-survivor groups (0.277 and 0.199). The levels of PEEP used were below 16 and 11 cmH2O in 93.46% and 67.38% of cases, respectively. Complications of PEEP which included barotrauma and hypotension were found in 11 cases (23.9%) with a very high mortality rate (81.8%). There were 28 deaths of patients in this study, giving an overall 60.8% group mortality rate. Despite the similarities in most clinical profiles, the survivors, when compared to the non-survivors, showed a greater extent of improved oxygenation in response to the application of PEEP, with fewer PEEP complications. The present study would, hopefully, provide the Thai clinicians with valuable informations in the management of ARDS.
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PMID:Adult respiratory distress syndrome in Thai medical patients. 913 93

Actin is present in high concentrations in most eukaryotic cells and can polymerize into filaments under physiological buffer conditions. As a result of tissue injury and cell lysis, large quantities of actin are released locally and may obstruct the downstream microvasculature, causing further damage to already injured organs. It has been postulated that this mechanism contributes to the development of the adult respiratory distress syndrome and to the diverse complications of falciparum malaria. Actin scavenging proteins--e.g., gelsolin--counteract the effects of extracellular actin, but the capacity of these plasma proteins can be overwhelmed by massive tissue injury. We examined the temporal relationship between serum levels of gelsolin (and tumor necrosis factor-alpha) and the clinical findings for a patient with severe falciparum malaria. The level of gelsolin decreased and then increased as the patient's status first worsened and then improved. We could not determine whether gelsolin served a biologically important function in this patient's recovery or was simply an epiphenomenon of disease activity. Gelsolin levels may be an early prognostic indicator in patients with a systemic inflammatory response syndrome. Moreover, the potential therapeutic role of recombinant human plasma gelsolin in patients with delayed organ dysfunction that commonly follows a self-limited initial insult merits investigation.
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PMID:Temporal association between serum gelsolin levels and clinical events in a patient with severe falciparum malaria. 914 99

Two groups of sixteen cases of severe complicated falciparum malaria on two different regimens of treatment were retrospectively studied. The first group including 12 patients, were treated by anti malarial drugs alone. The second group including 4 patients, were treated by exchange transfusion. Multisystemic complications were observed in both groups. It was observed that in complicated Acute Respiratory Distress Syndrome (ARDS), renal and hyperparasitemia were > 30 per cent. The result of the exchange transfusion group was superior to the non exchange group. Exchange transfusion is therefore recommended in the treatment of malarial patients who present with parasitemia > 30 per cent and severe multisystemic complications particularly those who have severe acute renal failure or have lung complications. The amount of blood used for each exchange transfusion should be at least 10-14 units for rapid removal of parasites and toxic metabolites from the circulation.
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PMID:Exchange transfusion therapy in severe complicated malaria. 917 78

Severe and complicated malaria is an important cause of mortality in Plasmodium falciparum infection. We describe in this study the details of 532 cases of such syndromes admitted to hospital during an outbreak of malaria between September-December 1994. Increase in the annual rain fall, collection of water around Indra Gandhi Canal, forestation of shrubs around it and migration of labor, adaptation of Anopheles stephensi to desert climate and favorable breeding of An. culicifacies in the areas under impact of irrigation were presumptive causes of the outbreak in this region. Cerebral malaria (25.75%), hepatic involvement (11.47%), spontaneous bleeding (9.58%), hemoglobinuria (7.89%), severe anemia (5.83%), algid malaria (5.26%), ARDS (3%) and renal failure (2.07%) were the important manifestations. The overall mortality was 11.09%, which was high because of infection in the non-immune population of this area. Ignorance about the severity of this disease and lack of transportation facility was another important factor. Morality was highest in ARDS (81.25%) followed by severe anemia (70.97%), algid malaria (46.43%), renal failure (45.45%), jaundice (36.06%) and cerebral malaria (33.57%). Pregnancy was an important determinant increasing the mortality in female patients. Mortality was very high (82.35%) in those persons who presented with more than 3 syndromes together.
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PMID:Severe and complicated malaria in Bikaner (Rajasthan), western India. 944 3

A 25-year-old male, who had returned from the Republic of Mali in Africa, was admitted to our hospital because of a 3-day history of high fever, on the first of October 1996. He was diagnosed as Plasmodium falciparum malaria by peripheral blood smear. From the admission day he was treated with quinine HCL, 1,500 mg per day, and sulfamethoxazole 2,400 mg trimethoprim 480 mg per day, but on October 2nd blood examination showed 35% parasite density and he was given mefloquine. However he was complicated with DIC on October 3rd, ARDS on October 5th. By anti-coagulant therapy and methylprednisolone pulse therapy he became afebrile and respiratory function improved rapidly. ARDS should be emphasized as a severe complication of imported severe malaria.
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PMID:[Acute respiratory distress syndrome complicating imported Plasmodium falciparum malaria]. 954 90

Acute renal failure, disseminated intravascular coagulation, ARDS, hypoglycaemia, coma or epileptic seizures are manifestations of severe Plasmodium falciparum malaria. On the other hand, vivax malaria or benign tertian malaria is usually free from complications. In the present report we describe a case of acute tertian malaria with a severe and complicated course. In this situation bacterial coinfection should always be suspected and treated empirically with broad-spectrum antibiotics, until the results of cultures are available. Mixed plasmodial infection (P. vivax and P. falciparum) must be excluded by repeated and meticulous examination of blood smears. Newer techniques such as PCR processing or ParaSight F Test are mentioned.
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PMID:[ARDS in plasmodium vivax malaria]. 969 37


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