Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Approximately 90% of mortality due to malaria is in African children, but criteria to guide the recognition and management of severe malaria have not been validated in them. Findings are presented from a prospective study of all children admitted to the pediatric ward of a Kenyan district hospital with a primary diagnosis of malaria. The authors calculated the frequency and mortality rate for each of the clinical and laboratory criteria in the World Health Organization (WHO) definition of severe malaria, and then used logistic-regression analysis to identify the variables with the greatest prognostic value. 1844 children of mean age 26.4 months were seen. Not included were 18 children who died on admission and 4 who died of other causes. The mortality rate was 3.5% and 84% of the deaths occurred within 24 hours of admission. Impaired consciousness carried a relative risk of 3.3; respiratory distress, 3.9; hypoglycemia, 3.3; and jaundice, 2.6. 54 of the 64 children who died had impaired consciousness, respiratory distress, or both. This bedside index thus identified 84.4% of the fatal cases compared to only 79.7% identified by current WHO criteria. The presence of impaired consciousness or respiratory distress can therefore identify which African children with malaria are at high risk of dying.
 ...
PMID:Indicators of life-threatening malaria in African children. 772 3

A 67-year-old male was admitted with consciousness disturbance (JCS, III-200) after completing a 12-day tour to east Africa without malaria chemoprophylaxis. When he visited the hospital one day prior to the admission complaining of fever and a slightly sore throat, he did not mention the travel history. Soon after his travel history was revealed, blood films were prepared which showed abundant ring forms accompanied with a small number of trophozoites and schizonts of Plasmodium falciparum, with the parasitemia of 26%. Despite intravenous quinine infusion, first that of loading dose, his consciousness state (JCS, III-300), renal and hepatic functions and anemia (Hb, 5.8 g/dL) deteriorated progressively. Moreover, metabolic acidosis worsened with pH of 6.954, HCO3- of 3.4 mEq/L, BE of--27.0 mEq/L, PCO2 15.5 mmHg by arterial blood gas analysis, although he received a large volume of sodium bicarbonate solution. The patient died on the 4th day of his illness. According to the literature, it is suggested that the treatment of metabolic acidosis in severe faciparum malaria with sodium bicarbonate is sometimes harmful, since it can result in sodium overloading, which may then precipitate pulmonary edema/ARDS. However, alternative treatment regimens have not yet been established. Future investigation on the etiology and the proper treatment of metabolic acidosis associated with severe falciparum malaria is highly needed.
 ...
PMID:[A rapidly fatal case of severe falciparum malaria complicated with high-level metabolic acidosis]. 1086 Mar 64

Cerebral malaria (CM) is a life-threatening complication of falciparum malaria and some types of disturbed consciousness problems are major symptoms of CM. Although the pathogenesis of CM is unknown, the sequestration, the binding of red blood cells containing mature stages of the malaria parasite to the endothelium of the cerebral microvasculature, and the disappearance of erythrocytes infected with mature malaria parasite in the peripheral blood stream, are thought to play a key role in its pathogenesis. Falciparum malaria patients with disturbed consciousness should be considered to suffer from CM; however it should also be examined as to whether other disease complications such as meningitis or hypoglycemia are associated with this condition. The brain CT or MRI of CM patients reveal no specific findings. CM is treated with an intravenous infusion of artesunate or an intravenous drip infusion of quinine. The prognosis of CM patients is very poor without rapid and adequate treatment; therefore, CM is an infectious disease warranting emergency treatment. The number of Japanese CM patients is believed to increase in the near future in accordance with the increase in the number of Japanese travelers visiting tropical or subtropical malaria-endemic areas. Therefore, Japanese clinicians should also be aware of CM, in case a falciparum malaria patient with some consciousness disturbance visits the clinic.
 ...
PMID:[Cerebral malaria]. 1923 61