Severe malaria: update on pathophysiology and treatment
| Autor: | Josef A Brejt, Linnie M. Golightly |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty 030106 microbiology MEDLINE Artesunate Disease 03 medical and health sciences Antimalarials 0302 clinical medicine parasitic diseases Medicine Humans Severe Malaria 030212 general & internal medicine Malaria Falciparum Intensive care medicine biology business.industry Extramural Plasmodium falciparum medicine.disease biology.organism_classification Pathophysiology United States Infectious Diseases Administration Intravenous business Neurocognitive Malaria |
| Zdroj: | Current opinion in infectious diseases. 32(5) |
| ISSN: | 1473-6527 |
| Popis: | Malaria threatens the lives of over 200 million individuals with the disease each year. Plasmodium falciparum is the predominant cause of severe malaria which may be lethal and result in neurocognitive sequelae despite appropriate treatment. We review recent advances regarding the pathophysiology of severe malaria and treatment recommendations for severe disease in the United States.Infected red blood cell (iRBC) sequestration in microvascular beds is a critical factor in the development of severe malaria syndromes. Interactions between iRBC variant adhesive peptides and the endothelial protein C receptor (EPCR) result in perturbations of coagulation and cytopreservation pathways. Alterations in the protein C/EPCR axis are implicated in cerebral malaria, respiratory distress, and anemia. Brain MRIs reveal the posterior reversible encephalopathy syndrome in cerebral malaria patients. Transcriptomic analysis reveals commonalities in disease pathogenesis in children and adults despite differences in clinical presentation. US guidelines for severe malaria treatment currently recommend intravenous artesunate including in pregnant women and children.Despite advances in our understanding of malarial pathogenesis much remains unknown. Antimalarial agents eradicate parasites but no treatments are available to prevent or ameliorate severe malaria or prevent disease sequelae. Further study is needed to develop effective adjunctive therapies. |
| Databáze: | OpenAIRE |
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