Successful treatment of malaria tropica with acute renal failure and cerebral involvement by plasmapheresis and hemodialysis

Abstract

A non-immune, 31-year-old woman developed an acute infection with Plasmodium falciparum after travelling to Kenia. The parasites proved resistant to chloroquine and sulfadoxine/pyrimethamine. The course of the disease was complicated by acute renal failure, hepatocellular damage, disorders of blood coagulation, thrombocytopenia, hemolysis and cerebral involvement. Despite a very high level of parasitemia (50% parasitized erythrocytes) a rapid clinical improvement was achieved by plasmapheresis and hemodialysis. Our experience shows that plasmapheresis and hemodialysis are excellent additive methods which rapidly improve clinical symptoms and may reduce morbidity and mortality in severe malaria tropica.

Considerations on the use of adjunct red blood cell exchange transfusion in the treatment of severe Plasmodium falciparum malaria

“…50 These benefits likely outweigh the potential benefit 23 of whole blood manual ET, such as the postulated removal of parasitic toxins and cytokines such as interleukin-1 and TNF-a. Although one report suggested that plasmapheresis after erythrocytapheresis was associated with clinical improvement in a case of severe malaria, 51 TNF-a levels were variable and do not correlate with clinical outcomes. 18 Use of ET when conventional antimalarials were not medically tolerated or unavailable.…”

Therapeutic plasma exchange in the treatment of complicated Plasmodium falciparum malaria: A case report

“…But no evidence exists to support its efficacy as adjunctive therapy in severe malaria. Cytokines such as tumor necrotic factor (TNF‐α) and interleukin‐1 (IL‐1) probably contribute to the pathogenesis of severe malaria, and several case reports have suggested that plasma exchange is an effective adjunctive therapy . Here, we report a patient with P. falciparum malaria treated successfully with intravenous artesunate and adjunctive therapy with plasma exchange.…”

Exchange transfusion combined with artesunate (ET-AS) as a safe and effective therapy in severe P. falciparum malaria: a case series

“…RCE is said to reduce parasite load, remove toxic substances and reduce microcirculatory sludging, which offers adjunct and rapid approach in severe P. falciparum malaria [4]. Some researchers have suggested therapeutic benefit of RCE for patients with pulmonary, renal, and cerebral complications in severe P. falciparum malaria [5,6]. Unfortunately, no large-scale randomized clinical trials have been conducted to date comparing RCE as an adjunct therapy for malaria [7,8].…”