The Pathogenesis of Severe Malaria

1.我们在曼谷热带病医院ICU检查了95例脑型疟疾患者。(1)脑内恶性疟原虫感染的红细胞与毛细血管的隔离是脑型疟疾的一个特征。我们在重症疟疾患者的皮下组织中发现了类似的毛细血管隔离。在恒河猴脑疟疾模型上，观察到脑内和皮下组织的滞留率之间的关系。(2)根据胃粘膜内的pH值，将患者分为正常和低两组。低(<7.3)组死亡率较高。结果：1.持续低胃黏膜pH者全部死亡。我们于1997年6月15日和16日在日本东京的鹿津市组织了一次名为“疟疾研讨会”的国际会议。约50名疟疾专家参加了会议，讨论了疟疾研究的最新成果和信息。对当今疟疾复发危机的理解，…更多的与会者相信在疟疾流行地区开展国际合作试验的必要性。虽然青蒿素是一种特效的抗脑疟疾药物，但在治疗过程中有时会出现复发。然后，我们试图提高青蒿素在脑型疟疾治疗中的应用。然后，我们试图通过青蒿琥酯(青蒿素衍生物)和其他抗疟疾药物(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络合剂，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，以检测这两种药物之间是否存在拮抗作用。我们观察了101例接受青蒿琥酯和安慰剂或青蒿琥酯和去铁胺联合治疗的严重恶性疟疾患者，并进行了随机、双盲、前瞻性研究。统计分析表明，这两种抗疟疾药物之间没有拮抗作用。我们得出结论，青蒿琥酯和去铁胺联合治疗重症疟疾是安全有效的，并可能加速肝细胞功能障碍的恢复。较少

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