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Cerebral Malaria Treated with Artemisinin in the Intensive Care Unit: A Case Report.

Çizmeci EA, Kelebek Girgin N, Ceylan I, Tuncel T, Alver O, Akalin EH - Iran J Parasitol (2016 Jan-Mar)

Bottom Line: Intravenous artemisinin was continued for 10 days.Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fevers ceased.Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Intensive Care, School of Medicine, Uludag University, Bursa, Turkey.

ABSTRACT
Malaria is a parasitic disease that is starting to be encountered in intensive care units (ICU) worldwide, owing to increasing globalisation. Severe malaria caused by Plasmodium falciparum, is characterised by cerebral malaria, acute renal failure, hypoglycaemia, severe anaemia, splenomegaly and alveolar oedema. We present the case of a 25-yr old male patient who presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fever for three days. His medical history revealed a 14-month stay in Tanzania. Staining of blood smears revealed characteristic gametocytes in accordance with P. falciparum infection. The day after admission, he had an epileptic seizure after which his Glasgow Coma Scale was 6, so he was intubated and transferred to the ICU. A computerized tomography scan revealed findings of cerebral oedema. Intravenous mannitol was administered for 6 days. Intravenous artemisinin was continued for 10 days. Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fevers ceased. This case emphasizes that cerebral malaria should be suspected in cases of seizures accompanying malaria, and treatment should be initiated in the ICU. Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking.

No MeSH data available.


Related in: MedlinePlus

Ring-form trophozoites of P. falciparum in a thin blood smear (Original picture)
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F2b: Ring-form trophozoites of P. falciparum in a thin blood smear (Original picture)

Mentions: A 25-yr old male patient presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fever and chills for the past three days. His medical history revealed that his fever started upon return from a 14-month stay in Tanzania. Physical examination was normal except for mild sensitivity in the upper right quadrant of the abdomen and a fever of 37.8 °C. Laboratory results showed counts of white blood cells (WBC): 3230/μL, platelets: 26.800/μL, and haemoglobin (Hb): 14.3 g/dL. Other remarkable measurements included aspartate aminotransferase (AST): 145 IU/L, alanine aminotransferase (ALT): 142 IU/L, total bilirubin: 3.4 mg/dL, direct bilirubin: 2.1 mg/dL, and C-reactive protein (CRP): 13.8 mg/dL. The chest radiogram was unremarkable. The patient was admitted after consultation with an infectious diseases specialist with a suspicion of malaria. Staining of thick and thin blood smears revealed characteristic gametocytes (Fig. 1, 2a and 2b) in accordance with P. falciparum malaria infection and he was commenced on a course of intravenous artemisinin (2.4 mg/kg).


Cerebral Malaria Treated with Artemisinin in the Intensive Care Unit: A Case Report.

Çizmeci EA, Kelebek Girgin N, Ceylan I, Tuncel T, Alver O, Akalin EH - Iran J Parasitol (2016 Jan-Mar)

Ring-form trophozoites of P. falciparum in a thin blood smear (Original picture)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4835461&req=5

F2b: Ring-form trophozoites of P. falciparum in a thin blood smear (Original picture)
Mentions: A 25-yr old male patient presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fever and chills for the past three days. His medical history revealed that his fever started upon return from a 14-month stay in Tanzania. Physical examination was normal except for mild sensitivity in the upper right quadrant of the abdomen and a fever of 37.8 °C. Laboratory results showed counts of white blood cells (WBC): 3230/μL, platelets: 26.800/μL, and haemoglobin (Hb): 14.3 g/dL. Other remarkable measurements included aspartate aminotransferase (AST): 145 IU/L, alanine aminotransferase (ALT): 142 IU/L, total bilirubin: 3.4 mg/dL, direct bilirubin: 2.1 mg/dL, and C-reactive protein (CRP): 13.8 mg/dL. The chest radiogram was unremarkable. The patient was admitted after consultation with an infectious diseases specialist with a suspicion of malaria. Staining of thick and thin blood smears revealed characteristic gametocytes (Fig. 1, 2a and 2b) in accordance with P. falciparum malaria infection and he was commenced on a course of intravenous artemisinin (2.4 mg/kg).

Bottom Line: Intravenous artemisinin was continued for 10 days.Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fevers ceased.Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Intensive Care, School of Medicine, Uludag University, Bursa, Turkey.

ABSTRACT
Malaria is a parasitic disease that is starting to be encountered in intensive care units (ICU) worldwide, owing to increasing globalisation. Severe malaria caused by Plasmodium falciparum, is characterised by cerebral malaria, acute renal failure, hypoglycaemia, severe anaemia, splenomegaly and alveolar oedema. We present the case of a 25-yr old male patient who presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fever for three days. His medical history revealed a 14-month stay in Tanzania. Staining of blood smears revealed characteristic gametocytes in accordance with P. falciparum infection. The day after admission, he had an epileptic seizure after which his Glasgow Coma Scale was 6, so he was intubated and transferred to the ICU. A computerized tomography scan revealed findings of cerebral oedema. Intravenous mannitol was administered for 6 days. Intravenous artemisinin was continued for 10 days. Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fevers ceased. This case emphasizes that cerebral malaria should be suspected in cases of seizures accompanying malaria, and treatment should be initiated in the ICU. Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking.

No MeSH data available.


Related in: MedlinePlus