Severe malaria presenting to the ED: A collaborative approach utilizing exchange transfusion and artesunate

Zodda, David; Procopio, Gabrielle; Hewitt, K. C.; Parrish, Andrew; Balani, Bindu; Feldman, Joseph

doi:10.1016/j.ajem.2018.03.023

Cited by 7 publications

(4 citation statements)

References 8 publications

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“…Clinicians might be intrigued that there is currently no molecular explanation for why coma-recovery can be so rapid that patients begin speaking during the procedure. Having been frustrated by the gruesome deaths of children with CM, it is understandable that clinicians worldwide have repeatedly felt compelled to publish exchange-for-malaria case-reports describing stunning, unexpected recoveries -and continue to publish dramatic rescues in the 21st century [16][17][18][19][20][21].…”

Section: "Pathogenic Ligand" Cytoadhesion And/or Inflammation Referencesmentioning

confidence: 99%

Cerebral Malaria: Clinicians, Extracellular Vesicles, and Therapeutically-Rational Exchange (T-REX)

Jajosky,

Jajosky

2024

Preprint

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As new vaccines reduce P. falciparum (Pf) cases, clinicians can focus on rescuing more children with cerebral malaria (CM). Adjunctive “therapeutically-rational exchange transfusion” (T-REX) refers to using special “Pf-resistant” donor red blood cells (RBCs) that secrete nano-sized RBC extracellular vesicles (EVs). Can some RBC EVs rapidly dislodge Pf-infected RBCs (iRBCs) sequestered in blood vessels and reduce inflammation? Does post-exchange “rebound parasitemia” reflect sequestration-reversal? We reviewed case-reports, EV and liposome studies, expert perspectives, and time-sequence data. In the AQUAMAT study, median coma-recovery time was 20 hours for artesunate. In contrast, a CM patient treated with type-O T-REX quickly began speaking (during the procedure). For other rapid-recovery CM patients, donor RBC variables had not been specified. Despite rapid Pf-killing, drugs need 20 hours to substantially reduce iRBC cytoadhesion while EVs can selectively bind distant inflamed tissues within 15 minutes. RBCs stressed by blood-bank storage and Pf infection secrete EVs. Post-exchange “rebound parasitemia” can occur within 60 minutes and may reflect release of sequestered iRBCs. Sequestration-reversal can be assessed by monitoring Pf parasitemia and total Pf biomass. New data suggest clinicians, working with transfusion- and laboratory-medicine physicians, can, and should, assess T-REX options and publish their findings to help clarify how RBC EVs may serve as therapeutic “decoy ligands.”

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Section: "Pathogenic Ligand" Cytoadhesion And/or Inflammation Referencesmentioning

confidence: 99%

Cerebral Malaria: Clinicians, Extracellular Vesicles, and Therapeutically-Rational Exchange (T-REX)

Jajosky,

Jajosky

2024

Preprint

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“…His whole body parasitaemia went from 42% to 0.4% within 2 days since ART initiation and showed improved metabolic acidosis. After 18 days, he showed full neurological recovery and was discharged [ 59 ].…”

Section: Malaria and Its Parasite Life Cyclementioning

confidence: 99%

Recent Advances in the Therapeutic Efficacy of Artesunate

2022

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Artesunate, a semisynthetic artemisinin derivative, is well-known and used as the first-line drug for treating malaria. Apart from treating malaria, artesunate has also been found to have biological activity against a variety of cancers and viruses. It also exhibits antidiabetic, anti-inflammatory, anti-atherosclerosis, immunosuppressive activities, etc. During its administration, artesunate can be loaded in liposomes, alone or in combination with other therapeutic agents. Administration routes include intragastrical, intravenous, oral, and parenteral. The biological activity of artesunate is based on its ability to regulate some biological pathways. This manuscript reports a critical review of the recent advances in the therapeutic efficacy of artesunate.

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“…Most of the pa-tients in our study received only artemether-lumefantrine; four received artemether-lumefantrine and primaquine, one received quinine and primaquine, and three patients re-ceived artemether-lumefantrine following intravenous artesunate. The utilization of the anti-malarial medication artesunate in conjunction with exchange transfusion demonstrated effica-cy and safety in patients suffering from severe malaria and neurological complications (21). An exchange blood transfusion and artesunate treatment were applied to two malaria patients.…”

Section: Figure 2 World Map; Countries With Indigenous Cases and Thei...mentioning

confidence: 99%

How should Travel-Related Malaria Management in Emergency Departments of Non-endemic Countries? Single-center Study

Gun

Aldinc

ORHAN

et al. 2022

Acibadem Univ Saglik Bilim Derg

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Purpose: Advancements in air travel enabled an increase in traveling to malaria-endemic countries such as those in sub-Saharan Africa. An increase in the incidence of imported malaria accompanied these advancements. This study aims to summarize how malaria patients who have imported the disease into non-endemic countries present to the emergency departments and to enlighten physicians in emergency departments by providing suggestions for practical approaches to handling such situations. Methods: This study was conducted retrospectively in a university hospital, from January 1, 2014 to March 1, 2022. Seven years of emergency department records of patients who were examined in the emergency department with a suspected, or definitive diagnosis of malaria were included in the study. Epidemiological and clinical characteristics were evaluated. Results: 892 patients were admitted to the emergency department with suspicion of malaria. Thirty of these patients were diagnosed with malaria, and 846 of the 892 patients were members of airline cabin crews. 94.3% (n=798) of the cabin crew did not use prophylactic medication for malaria. The mean age of the patients was 33.2±8.5. Twenty-five patients were diagnosed via peripheral blood smears, and the remaining three patients were diagnosed with PCR. Rapid diagnostic tests were positive in 26 out of 28 patients. Conclusion: The risk of acquiring malaria is still high despite short-term visits and airport-limited stays. Travel history should be routinely asked of patients by emergency physicians. Education of people traveling to malaria-endemic countries, including cabin crew, regarding malaria prophylaxis and protective measures to prevent mosquito bites plays a crucial role in preventing malaria.

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Severe malaria presenting to the ED: A collaborative approach utilizing exchange transfusion and artesunate

Cited by 7 publications

References 8 publications

Cerebral Malaria: Clinicians, Extracellular Vesicles, and Therapeutically-Rational Exchange (T-REX)

Cerebral Malaria: Clinicians, Extracellular Vesicles, and Therapeutically-Rational Exchange (T-REX)

Recent Advances in the Therapeutic Efficacy of Artesunate

How should Travel-Related Malaria Management in Emergency Departments of Non-endemic Countries? Single-center Study

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