The Pathogenesis of Severe Malaria

1.我们检查了曼谷热带病医院ICU的95例脑型疟疾患者。(1)脑型疟疾的一个特征是脑内毛细血管与恶性疟原虫感染的红细胞隔离。我们在严重疟疾患者的皮下组织中发现了类似的毛细血管隔离。在恒河猴脑型疟疾模型中，观察到脑内和皮下组织的隔离率之间的相关性。(2)根据胃粘膜内pH值，将患者分为两组（正常或低）。低剂量组（<7.3）死亡率较高。所有持续性胃粘膜内pH低的患者均死亡。我们于1997年6月15、16日在日本东京霞关组织了一次国际会议“疟疾讲习班”。约50名疟疾专家参加了会议，并讨论了疟疾研究的最新成果和信息。了解当今疟疾复发的危机， ...更多信息 与会者强调了在疟疾流行区开展国际合作试验的必要性.青蒿素是一种特效抗脑疟药，但在治疗过程中有时会出现复发。因此，我们尝试加强青蒿素在脑型疟治疗中的应用。然后，我们尝试通过青蒿素酯（青蒿素衍生物）与其他抗疟药（去铁胺）的组合来提高青蒿素在脑型疟疾治疗中的使用。由于去铁胺是一种铁螯合剂，而青蒿素的活性依赖于铁，因此必须首先检查两种药物之间的拮抗作用。因此，我们（日本、泰国和美国合作小组）在曼谷热带病医院进行了一项初步试验，以检测两种药物之间的任何拮抗作用。对101例成人恶性疟重症患者分别用青蒿琥酯、安慰剂或青蒿琥酯与去铁胺联合治疗，进行随机、双盲、前瞻性研究。统计学分析表明，两种抗疟药之间无拮抗作用。我们的结论是，青蒿酸盐和去铁胺的组合是安全和有效的治疗严重疟疾，并可能加快从肝细胞功能障碍的恢复。少

1. We examined 95 cerebral malaria patients in the ICU of Bangkok Hospital for Tropical Diseases.(1) Sequestration of blood capillary with P.falciparum-infected red blood cells in the brain is a characteristic future of cerebral malaria. We found similar capillary sequestration in subcutaneous tissues in severe malaria patients. In a rhesus monkey model of cerebral malaria, cor relation between sequestration rates in the brain and subcutaneous tissues was observed.(2) According to a gastric intramucosal pH value, patients were divided into two groups (normal or low). The mortality rate was greater in low (less than 7.3) group. All patients with persistently low gastric intramucosal pH died.2. We organized an international meeting, "MALARIA WORKSHOP" on June 15,16,1997 at kasumigaseki in Tokyo, Japan. About 50 malaria specialists participated to the meeting and discussed the latest results and information on malaria studies. Understanding of today's crisis of malaria recrudescence, the … More participants convinced the necesity of international cooperative trials in malaria endemic regions.3. While qinghaosue is a specific anti-cerebral malarial, recrudence sometimes occurs during the treatment with this drug. Then, we tried to enhance the usage of qinghaosue in cerebral malaria treatment with this drug. Then, we tried to enhance the usage of qinghaosue in cerebral malaria treatments by a combination of artesnate (qinghaosue derivative) and other anti-malarial (deferoxamine). Since deferoxamine is an iron chelator and qinghaosue's activity depends on iron, antagonism between the two drugs must be examined at first. Therfore, we (Japan, Tailand, and USA cooperative team) conducted a preliminary trial to detect any antagonism between the two drugs in the Bangkok Hospital for Tropical Diseases. We obsrved 101 adults with severe P.falciparum Malaria admitted with artesnate and placebo or the combination of artesnate and deferoxamine, and conducted randomized, double-blind, prospective study. Statisical analysis showed no evidence for antagonism between the two anti-malarials. We conclude that the combination of artesnate and deferoxamine is safe and effective for treatment of severe malaria and may hasten recovery from hepatocellular dysfunction. Less