Title: Exchange Transfusion and Predictors of Outcome in Severe Falciparum Malaria
Authors: AE Mathew, AJ Mathew, D Tariang, S Longtrai, GM Varghese
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.50
Abstract
Introduction
With an estimated 300-350 million cases and 1-3 million deaths, annually, malaria continues to be a major health concern especially in Sub-Saharan Africa and South-East Asia.1 In India malaria has staged a comeback after the early 1960s when an all-time low of malaria cases (49,151 in 1963) seemed to suggest the possibility of an impending eradication. During the last few years India has recorded about 2 million confirmed malarial cases and 1,000 deaths annually. These figures reveal just the tip of the iceberg as the WHO estimates about 15 million cases and 20,000 deaths annually.2 Severe malaria occurs when the effective treatment is delayed, either because of poor access to health care and delay in diagnosis or because the drugs given are ineffective in rapidly clearing the parasite.3 Non-immune individuals are particularly susceptible to severe falciparum malaria. Multiple organ dysfunction occurs once the disease takes a severe course, causing mortality as high as 50%. There is little pharmaceutical interest in development of new drugs due to low monetary returns on investment4 and there have been no major advances since the extraction of artemesinin and its derivatives in the early 1970s. With the recent emergence of geographical areas of artemesinin resistance,5 research and development of new drugs as well as revisiting available treatment modalities is a pressing need.
References
1. Malaria Facts. Centers for Disease Control and Prevention.
2. Ashwani Kumar, Neena Valecha, Tanu Jain, Aditya P. Dash. Burden of Malaria in India: Retrospective and Prospective View. Am. J. Trop. Med. Hyg., 77 (6_Suppl), 2007, pp. 69-78
3. Dondorp AM, Day NP. The treatment of severe malaria.Trans R Soc Trop Med Hyg. 2007;101:633-4
4. White NJ. The treatment of malaria. NEJM. 12.9.1996;335:11:800-806
5. Arjen M. Dondorp et al, M.D.Artemisinin Resistance in Plasmodium falciparu-m Malaria. Volume 361:455-467 July 30, 2009 Number 5
7. G.D. Burchard et al. Exchange blood transfusion in severe facliparum malaria: Retrospective analaysis of 61 patients treated with compared to 63 patients treated without exchange transfusion. Trop. Med and Int. Health, Vol 2 No 8 PP 733-740, Aug 97
8. WhiteNJ. What is the future of exchange transfusion in severe malaria? J Infect 1999;39:185-6.
9. Dondorp AM, Angus BJ, Hardeman MR, Chotivanich KT, Silamut K, Ruangveera-yuth R, Kager PA, WhiteNJ, Vreeken J. Prognostic significance of reduced red blood cell deformability in severe falciparum malaria. Am J Trop Med Hyg 1997;57:507-11.
10. Kumar S, Karnad DR, Vaingankar J, Thatte UM, Krishnan A, Rege NN. Serum tumour necrosis factor alpha levels in severe malaria: effect of partial exchange transfusion. Intensive Care Med 2003;29:1857-8.
11. World Health Organization Severe falciparum malaria. Trans R Soc Trop Med Hyg.2000;94(suppl 1):S1–S90.
12. Hoontrakoon S, Suputtamongkol Y. Exchange transfusion as an adjunct to the treatment of severe falciparum malaria. Trop Med Int Health 1998;3:156-61.
13. Nieuwenhuis JA, Meertens JH, Zijlstra JG, Ligtenberg JJ, Tulleken JE, van der Werf TS. Automated erythrocytapher-esis in severe falciparum malaria: a critical reappraisal.Acta Trop 2006;98:201-6.
14. Andrej Trampuz, Matjaz Jereb, Igor Muz-lovic, and Rajesh M Prabhu.Clinical revie-w: Severe malaria. Crit Care. 2003; 7(4): 315–323.
15. Riddle MS, Jackson JL, Sanders JW, Blazes DL. Exchange transfusion as an adjunct therapy in severe Plasmodium falciparum malaria: a meta-analysis. Clin Infect Dis. 2002;34:1192–1198. doi: 10.1086/339810.
16. WHO. Guidelines for the treatment of malaria, second edition, 2010
17. Chloroquine resistant P. falciparum mala-ria in Assam and Meghalaya. Barkakaty BN, Kalita PC, Das S, Talukdar AC.
18. Guidelines for Diagnosis and Treatment of malaria in India, 2009. Govt. of India Publication
19. Blaise Genton, Valérie D' Acrem-ont, Lawrence Rare, Kay Bae, John C. Reeder, Michael P. Alpers, Ivo Müller. Plasmodium vivax and Mixed Infections Are Associated with Severe Malaria in Children: A Prospective Cohort Study from Papua New Guinea. PLoS Medicine. June 2008
20. Fabiana P. Alves, Rui R. Durlacher, Maria J. Menezes, Henrique Krieger, Luiz H. Pereira da Silva, Erney P. Camargo. High prevalence of Aymptomatic Plasmodium vivax and Plasmodium falciparum infections in native Amazonian populations. Am. J. Trop. Med. Hyg., 66(6), 2002, pp. 641–648
21. Luxemburger C, Ricci F, Raimond D, Bathet S, White NJ. The epidemiology of severe malaria in an area of low transmission in Thailand. Trans R. Soc Trop Med Hyg. 1997;91:256-62.
22. Perry J.J. van Genderen, Dennis A. Hesselink, Jacob M. Bezemer, Pieter J. Wismans and David Overbosch. Efficacy and safety of exchange transfusion as an adjunct therapy for severe Plasmodium falciparum malaria in nonimmune trave-lers: a 10-year single-center experience with a standardized treatment protocol. TRANSFUSION 2010;50:787-794.
23. Suresh G. Shelat, Jason P Lott, and Matthew S. Braga. Considerations on the use of adjunct red blood cell exchange transfusion in the treatment of severe Plasmodium falciparum malaria. TRANSFUSION 2010;50:875-880.