The Pathogenesis of Severe Malaria

点击翻译按钮获取中文摘要

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