Brain Swelling and Mannitol Therapy in Adult Cerebral Malaria: A Randomized Trial

Mohanty, Sanjib; Mishra, Saroj K.; Patnaik, Rajyabardhan; Dutt, Anil Kumar; Pradhan, Sudhir; Das, B.K.; Patnaik, J.K.; Mohanty, Akshaya Kumar; Lee, Sue J.; Dondorp, Arjen M.

doi:10.1093/cid/cir405

Cited by 84 publications

(88 citation statements)

References 31 publications

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“…21,24 Mild diffuse brain swelling is found in a variety of anatomical sites. This swelling is partly attributed to venous congestion by the sequestered IRBC mass causing increased cerebral blood volume.…”

Section: Clinical Evidence Of Barrier Dysfunction In Severe Malariamentioning

confidence: 99%

“…Unfortunately, mannitol infusion failed to show therapeutic benefit but instead was associated with prolongation of coma. 24 The contribution of leukocytes to endothelial barrier function in CM is also controversial. Histological sections of the adult brain in CM are notable for the almost complete absence of leukocyte infiltrates.…”

Section: Clinical Evidence Of Barrier Dysfunction In Severe Malariamentioning

confidence: 99%

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Dynamic interactions ofPlasmodiumspp. with vascular endothelium

Gillrie

2016

Tissue Barriers

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Plasmodial species are protozoan parasites that infect erythrocytes. As such, they are in close contact with microvascular endothelium for most of the life cycle in the mammalian host. The hostparasite interactions of this stage of the infection are responsible for the clinical manifestations of the disease that range from a mild febrile illness to severe and frequently fatal syndromes such as cerebral malaria and multi-organ failure. Plasmodium falciparum, the causative agent of the most severe form of malaria, is particularly predisposed to modulating endothelial function through either direct adhesion to endothelial receptor molecules, or by releasing potent host and parasite products that can stimulate endothelial activation and/or disrupt barrier function. In this review, we provide a critical analysis of the current clinical and laboratory evidence for endothelial dysfunction during severe P. falciparum malaria. Future investigations using state-of-the-art technologies such as mass cytometry and organs-on-chips to further delineate parasite-endothelial cell interactions are also discussed.

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Section: Clinical Evidence Of Barrier Dysfunction In Severe Malariamentioning

confidence: 99%

Section: Clinical Evidence Of Barrier Dysfunction In Severe Malariamentioning

confidence: 99%

Dynamic interactions ofPlasmodiumspp. with vascular endothelium

Gillrie

2016

Tissue Barriers

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“…This unique case is reported from the study site Ispat General hospital, a tertiary care industrial hospital at Rourkela, situated in the western part the state of Odisha, India which is a well characterized falciparum endemic region as per several epidemiological, molecular, and hospital based studies [3,[11][12][13].…”

Section: Introductionmentioning

confidence: 94%

Fatal Cerebral Malaria with Multi-Organ Dysfunction and Oleander Poisoning

Mohanty¹,

Sahu²,

Pattnaik³

et al. 2017

Malaria Contr Elimination

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Cerebral malaria is a clinical manifestation of the brain during Plasmodium falciparum infection, which may lead to fatal outcomes if left unattended or delayed in therapeutic management. It is often accompanied by multi-organ complications such as renal failure, respiratory distress, jaundice, severe anemia etc., further raising the degree of mortality. Over the years, the management of severe and cerebral malaria has improved radically but still the mortality rate in severe malaria is worrysome. An extremely uncommon case is demonstrated here, which is a classical illustration of malarial death due to CM and multi-organ dysfunction; complicated due to an episode of Oleander poisoning amidst. Falciparum malaria can have myriads of clinical presentations which may co-exist with other pathologies which is challenging for the clinicians, therefore, a high degree of suspicion followed by early diagnosis of malaria, may be more frequently pronounced in healthcare settings in malaria endemic areas to improve overall outcome and better management of malaria control programs.

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“…However, if this occurs in the brain, intracranial pressure increases resulting in brain swelling and decreased cerebral perfusion pressure. Brain compression together with decreased perfusion may further aggravate the already existing hypoxia as observed in unconscious children and adults with CM (Newton et al 1994(Newton et al , 1997Mohanty et al 2011). Furthermore, when intracranial pressure is severely increased, brain stem compression and cardiorespiratory arrest may ensue which often results in death or neurologic sequelae upon survival.…”

Section: Altered Vasomotor Activitymentioning

confidence: 99%

The immunological balance between host and parasite in malaria

Deroost

Pham

Opdenakker

et al. 2015

FEMS Microbiology Reviews

111

143

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One sentence summary: The intricate balance between anti-malarial immunity and parasite virulence factors including immune evasion mechanisms determine the outcome of malaria infections, as imbalances resulting in exaggerated parasite growth, excessive inflammation or the combination of both result in severe pathology. Editor: Christian van Ooij ABSTRACTCoevolution of humans and malaria parasites has generated an intricate balance between the immune system of the host and virulence factors of the parasite, equilibrating maximal parasite transmission with limited host damage. Focusing on the blood stage of the disease, we discuss how the balance between anti-parasite immunity versus immunomodulatory and evasion mechanisms of the parasite may result in parasite clearance or chronic infection without major symptoms, whereas imbalances characterized by excessive parasite growth, exaggerated immune reactions or a combination of both cause severe pathology and death, which is detrimental for both parasite and host. A thorough understanding of the immunological balance of malaria and its relation to other physiological balances in the body is of crucial importance for developing effective interventions to reduce malaria-related morbidity and to diminish fatal outcomes due to severe complications. Therefore, we discuss in this review the detailed mechanisms of anti-malarial immunity, parasite virulence factors including immune evasion mechanisms and pathogenesis. Furthermore, we propose a comprehensive classification of malaria complications according to the different types of imbalances.

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Brain Swelling and Mannitol Therapy in Adult Cerebral Malaria: A Randomized Trial

Abstract: Mild cerebral swelling on CT-scan was common in adult patients with cerebral malaria, but severity of swelling was not correlated with coma depth or survival. Mannitol as adjunctive treatment for cerebral malaria prolonged coma duration and may be harmful.

Cited by 84 publications

References 31 publications

Dynamic interactions ofPlasmodiumspp. with vascular endothelium

Dynamic interactions ofPlasmodiumspp. with vascular endothelium

Fatal Cerebral Malaria with Multi-Organ Dysfunction and Oleander Poisoning

The immunological balance between host and parasite in malaria

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