Malaria, Cerebral

Publication Title: 
The American Journal of Tropical Medicine and Hygiene

One hundred and two children aged 0-10 years with cerebral malaria (Blantyre coma score of 2 or less) were randomly treated either with intramuscular arteether (3.2 mg/kg on Day 0, followed by 1.6 mg/kg on Days 1 to 4) or intravenous (i.v.) quinine dihydrochloride (20 mg of the salt/kg, followed by 10 mg of the salt/kg every 8 hr up to Day 6). Treatment with oral quinine sulfate (10 mg/kg every 8 hr) was substituted for i.v. quinine when the patient was able to take oral medicine.

Author(s): 
Moyou-Somo, R.
Tietche, F.
Ondoa, M.
Kouemeni, L. E.
Ekoe, T.
Mbonda, E.
Nsangou, C.
Jemea, B.
Guemkam, G.
Publication Title: 
The Journal of Infectious Diseases

A retrospective study of 261 Vietnamese adults with severe malaria was conducted to determine the relationship between cerebrospinal fluid (CSF) levels of metabolites of the kynurenine pathway, the incidence of neurologic complications, and the disease outcome. Three metabolites were measured: the excitotoxin quinolinic acid (QA); the protective receptor antagonist kynurenic acid (KA); and the proinflammatory mediator picolinic acid (PA). These measurements were related prospectively to CSF lactate levels. QA and PA levels were elevated, compared with those of controls.

Author(s): 
Medana, Isabelle M.
Hien, Tran Tinh
Day, Nicholas P.
Phu, Nguyen Hoan
Mai, Nguyen Thi Hoang
Chu'ong, Ly Van
Chau, Tran Thi Hong
Taylor, Anne
Salahifar, Houta
Stocker, Roland
Smythe, George
Turner, Gareth D. H.
Farrar, Jeremy
White, Nicholas J.
Hunt, Nicholas H.
Publication Title: 
Antimicrobial Agents and Chemotherapy

Penetration of cerebrospinal fluid (CSF) by artesunate and DHA was assessed in six adults with cerebral or severe malaria. Lumbar punctures were performed on admission and during convalescence, at 15 min (patient 1), 30 min (patient 2), 45 min (patient 3), 60 min (patient 4), 90 min (patient 5), and 120 min (patient 6) after intravenous administration of 120 mg of artesunate. No artesunate was detectable in CSF. In both studies, DHA levels in CSF increased with time while dihydroartemisinin levels in plasma fell.

Author(s): 
Davis, Timothy M. E.
Binh, Tran Quang
Ilett, Kenneth F.
Batty, Kevin T.
Phuöng, Hoang Lan
Chiswell, Gregory M.
Phuong, Vu Duong Bich
Agus, Cindy
Publication Title: 
BMJ (Clinical research ed.)

OBJECTIVE: To compare the efficacy and safety of rectal artemether with intravenous quinine in the treatment of cerebral malaria in children. DESIGN: Randomised, single blind, clinical trial. SETTING: Acute care unit at Mulago Hospital, Uganda's national referral and teaching hospital in Kampala. PARTICIPANTS: 103 children aged 6 months to 5 years with cerebral malaria. INTERVENTION: Patients were randomised to either intravenous quinine or rectal artemether for seven days.

Author(s): 
Aceng, Jane Ruth
Byarugaba, Justus S.
Tumwine, James K.
Publication Title: 
The Journal of Infectious Diseases

BACKGROUND: Central to the pathologic progression of human cerebral malaria (CM) is sequestration of Plasmodium falciparum-infected red blood cells (Pf-IRBCs) to the blood-brain barrier (BBB) endothelium. The molecular interactions between Pf-IRBCs and the BBB endothelium and their implications for barrier function are unclear. METHODS: The effects of Pf-IRBCs on the integrity of the BBB were assessed by electrical cell substrate sensing and by transendothelial electrical resistance measurements in an in vitro human BBB model.

Author(s): 
Tripathi, Abhai K.
Sullivan, David J.
Stins, Monique F.
Publication Title: 
Indian Pediatrics

We report two cases of Plasmodium vivax malaria (both aged 12 years) complicated by seizures and symptoms of diffuse meningoencephalitis. One had predominantly meningeal signs while in the other, purely encephalitis features were present. Both cases were treated with artesunate. Rarely, cerebral malaria is a presenting complication or occurs during the course of P. vivax infection.

Author(s): 
Thapa, Rajoo
Patra, Vikram
Kundu, Ritabrata
Publication Title: 
The American Journal of Pathology

Brain hemodynamics in cerebral malaria (CM) is poorly understood, with apparently conflicting data showing microcirculatory hypoperfusion and normal or even increased blood flow in large arteries. Using intravital microscopy to assess the pial microvasculature through a closed cranial window in the murine model of CM by Plasmodium berghei ANKA, we show that murine CM is associated with marked decreases (mean: 60%) of pial arteriolar blood flow attributable to vasoconstriction and decreased blood velocity.

Author(s): 
Cabrales, Pedro
Zanini, Graziela M.
Meays, Diana
Frangos, John A.
Carvalho, Leonardo J. M.
Publication Title: 
PloS One

BACKGROUND: Safe, cheap and effective adjunct therapies preventing the development of, or reducing the mortality from, severe malaria could have considerable and rapid public health impact. Oral activated charcoal (oAC) is a safe and well tolerated treatment for acute poisoning, more recently shown to have significant immunomodulatory effects in man.

Author(s): 
de Souza, J. Brian
Okomo, Uduak
Alexander, Neal D.
Aziz, Naveed
Owens, Benjamin M. J.
Kaur, Harparkash
Jasseh, Momodou
Muangnoicharoen, Sant
Sumariwalla, Percy F.
Warhurst, David C.
Ward, Stephen A.
Conway, David J.
Ulloa, Luis
Tracey, Kevin J.
Foxwell, Brian M. J.
Kaye, Paul M.
Walther, Michael
Publication Title: 
Bulletin of the World Health Organization

OBJECTIVE: To summarize the existing evidence on the efficacy of artemether and arteether, two artemisinin derivatives, versus quinine for treating cerebral malaria in children. METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and the http://clinicaltrials.gov web site. We also checked the reference lists of existing systematic reviews and of all trials identified by the above methods.

Author(s): 
Kyu, Hmwe Hmwe
Fernández, Eduardo
Publication Title: 
Malaria Journal

BACKGROUND: Artemisinins are the newest class of drug approved for malaria treatment. Due to their unique mechanism of action, rapid effect on Plasmodium, and high efficacy in vivo, artemisinins have become essential components of malaria treatment. Administration of artemisinin derivatives in combination with other anti-plasmodials has become the first-line treatment for uncomplicated falciparum malaria. However, their efficiency in cases of cerebral malaria (CM) remains to be determined.

Author(s): 
Waknine-Grinberg, Judith H.
Hunt, Nicholas
Bentura-Marciano, Annael
McQuillan, James A.
Chan, Ho-Wai
Chan, Wing-Chi
Barenholz, Yechezkel
Haynes, Richard K.
Golenser, Jacob

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