Failure Malaria Research Articles

STUDY OF ACUTE RENAL FAILURE IN MALARIA IN SOUTHERN RAJASTHAN

BACKGROUND: Wide spectrum of kidney and kidney-related disorders, ranging from urinary abnormalities like proteinuria (< 1gm/24 hour) to kidney failure, can be caused by plasmodium falciparum. Falciparum malaria causes more frequently renal failure. Renal failure incidence by falciparum is variable between 1-4%.2,3. Renal failure is uncommon in vivax malaria. METHODS: It is an observational cross-sectional study of 266 cases of malaria through biochemical and hematological analysis of the blood of patients suffering from malaria infections between Jan 2018 to July 2022. RESULTS: Out of 266 cases of malaria in the age group 14-80 years, acute renal failure was seen in 20 cases (7.5%). Out of 20 renal failure cases, the maximum cases were 15 (75%) caused by plasmodium falciparum then, 3 (15%) cases by plasmodium vivax, and 2(10%) cases by mix (PF & PV). The presenting feature were fever (75%), jaundice (20%), and splenomegaly (20%). The probable contributing factors for renal failure were hyperbilirubinemia 9 (45%), hemolysis 9 (45%) hypotension 1 (5%), and oliguria present in 8(40%). Haemodialysis is required in 7 (35%) patients. Mortality was noted in 5% (1/20) of patients. CONCLUSIONS: Acute renal failure is caused more commonly by plasmodium falciparum than plasmodium vivax malaria. Acute tubular necrosis due to renal ischemia is the dominant pathogenic mechanism. The malarial parasites are commonly associated with jaundice, hemolysis, thrombocytopenia, and hypotension. The prognosis of renal failure is better in P. vivax than in P. falciparum.

Treatment Failure in Malaria

Treatment failure in malaria is a major dilemma that health-care workers face throughout the country. True drug resistance is one of the causes after ruling out compliance and drug quality issues; the other causes being re-infection with a new strain of the parasite during the treatment period or, in the case of Plasmodium vivax, the release of hypnozoites from the liver. Since it is difficult, in the field, to identify the cause as being due to re-infection with a new strain of the parasite during the treatment period or, in the case of P. vivax, the release of hypnozoites from the liver, providing antimalarials to overcome drug resistance is the mainstay of therapy.

Collapsing glomerulopathy after Plasmodium falciparum infection

Malaria is a mosquito-borne infection caused by parasites of the genus Plasmodium and may present as a spectrum of diseases ranging from asymptomatic infection to death. The estimated 660 000 fatal cases annually are almost all caused by Plasmodium falciparum, due to the ability of this species to cause high parasitaemia and sequestration of the infected erythrocytes in the microvasculature of vital organs. P. falciparum is also the cause of the vast majority of cases of renal failure in malaria. The incidence of acute kidney injury (AKI) in P. falciparum is ∼1–5% in natives of endemic areas who have some degree of immunity, but is much higher in non-immune subjects, with reported incidences of up to 30% [1]. When AKI occurs, mortality is high and ranges from 15 to 45%. The World Health Organization therefore classifies malaria infection with AKI as severe malaria. We describe a patient with severe P. falciparum infection and AKI, in which renal biopsy revealed an unexpected cause.

Oliguric and non-oliguric acute renal failure in malaria in west zone of rajasthan, India-A comparative study

ObjectiveTo report a comparative clinical and histopathological study on oliguric and non-oliguric acute renal failure (ARF) in malaria. Method311 consecutive cases of malaria out of which 74 (23.79%) had ARF as per WHO criteria were conducted. Mean age was 32.58 (range 15–60 years) and male: female was 2:1. ResultMost of the cases developed ARF within 10 d of onset. 18 cases (11 falciparum, 2 mixed, 5 vivax) presented with oliguric and 56 (41 falciparum, 6 mixed, 9 vivax) with non-oliguric renal failure. Associated major manifestations were jaundice (75.68%), cerebral malaria (41.89%), bleeding manifestations (32.43%), severe anemia (27.03%), hypotension (25.68%), multi-organ failure (18.92%), severe thrombocytopenia (12.16%), and ARDS (8.11%). Kidney biopsy (n=20) showed acute tubular necrosis (n=7), Mesangioproliferative glomerulonephritis (n=4) or both (n=9). Hemodialysis was done in 8 cases of oliguric renal failure out of which 4 survived (average no. of session 2.9). ConclusionMost of the cases recovered within 3 weeks. Total mortality was 28.38% (n=21) and mortality was more in oliguric renal failure (72.22%) as compare to non-oliguric renal failure (14.29%).

Insuffisance rénale aiguë et paludisme à Plasmodium falciparum : à propos d’un cas

Malaria is an endemic disease caused by one of the several Plasmodium species. Severe malaria is mainly due to Plasmodium falciparum in highly endemic areas. Acute renal failure (ARF) is a criterion of malaria severity as defined by WHO. Often observed in adults, particularly in India and Southeast Asia, this complication remains a rare complication of malaria in children. We report a case of oliguric ARF that occurred in a 7-year-old girl a few days after the onset of fever. The vascular obstruction by parasitized erythrocytes often causing tubular necrosis is the primary mechanism of renal failure. As a possible diagnosis, hemolytic uremic syndrome, renal failure and quartan hemoglobinuric nephropathy are other possible causes of renal failure in malaria. Renal biopsy, which was not performed in our patient, would have been a great help, but was not available. The outcome was favorable with recovery of renal function after 3 weeks of diuretic therapy. This development is not always the rule and the prognosis depends on early diagnosis and treatment options.

Acute kidney injury in the tropics

Acute kidney injury (AKI) is one of the most challenging problems faced by clinicians in the tropics owing to its fast-changing burden. AKI in the tropics is strikingly different from that in the developed world in terms of etiology and presentation. In addition, there is a stark contrast between well-developed and poor areas in the tropics. The true epidemiological picture of AKI in the tropics is not well understood due to the late presentation of patients to tertiary centers. Infections remain the major culprit in most cases of AKI, with high mortality rates in the tropics. Human immunodeficiency virus–related AKI, related to nephrotoxicity due to antiretroviral therapy, is on the rise. Acute tubular necrosis and thrombotic microangiopathy are the most common mechanisms of AKI. A notable problem in the tropics is the scarcity of resources in health centers to support patients who require critical care due to AKI. This article reviews the unique and contrasting nature of AKI in the tropics and describes its management in each situation.

Respuesta terapéutica a mefloquina, estado nutricional y variantes alélicas del gen CYP3A4 en pacientes con malaria falciparum no complicada; Antioquia (Colombia)

Introducción: hay poca información sobre las relaciones entre la falla de la terapia antimalárica y algunos factores del hospedero (estado nutricional, fenotipo y genotipo del citocromo CYP450 que metaboliza el medicamento antipalúdico). Objetivo: explorar si la falla terapéutica de la mefloquina dada a pacientes con malaria falciparum no complicada se puede explicar por la influencia del estado nutricional del enfermo y del fenotipo y genotipo de su citocromo CYP3A4. Materiales y métodos: estudio de casos y controles no pareado. Pacientes: hombres y mujeres adultos, de Turbo y El Bagre (Antioquia, Colombia). Resultados: se evaluó la respuesta terapéutica en 46 enfermos; hubo solo tres fallas (6,5%); por la muy baja ocurrencia de falla terapéutica (n = 3/46), los resultados se presentan en forma descriptiva para los 46 pacientes. La relación dextrometorfano/3metoximorfinano fue 0,39 (mediana); 20% fueron metabolizadores lentos. Las concentraciones sanguíneas medianas de mefloquina a las 24 horas (C24h) y al día 14 (Cd14) fueron 1.363 + 397 ng/mL y 978 + 106 ng/mL, respectivamente. Los 46 pacientes presentaron el alelo CYP3A4*2 (silvestre). Conclusión: no se pudo evaluar con profundidad la relación entre la respuesta a la terapia antimalárica, por una parte y, por otra, la actividad del CYP450 y el estado nutricional, pero hubo hallazgos que justifican la evaluación y control de las características del hospedero en estudios posteriores de farmacocinética antimalárica.

Review: artesunate added to standard drug treatment reduces treatment failure in malaria

International Artemisinin Study Group. Artesunate combinations for treatment of malaria: meta-analysis. Lancet 2004;363:9–17. [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Q In patients with acute, uncomplicated Plasmodium falciparum malaria, does the addition of an...

Multiorgan failure in malaria: what we have learned over the past 10 years

Multiorgan failure in malaria: what we have learned over the past 10 years

Why is it that antimalarial drug treatments do not always work?

The objective of antimalarial drug treatment in severe malaria is to save the patient's life. In uncomplicated malaria it is to reduce the parasite biomass to zero, or down to a level where host defences can deal with the remainder. Treatment regimens with rapidly eliminated drugs must generally cover four asexual life-cycles (i.e. > 6 days for Plasmodium falciparum and P. vivax) to eradicate all the parasites in the blood. For slowly eliminated drugs, blood concentrations must exceed the parasites' minimum inhibitory concentration (and preferably the minimum parasiticidal concentration) until all parasites have been eradicated. Resistance means that there is a right shift in the concentration-effect relationship. This may be large and abrupt, as with the point mutations that confer pyrimethamine, sulphonamide or atovaquone resistance, or slow and gradual, as with the processes that determine resistance to chloroquine, quinine or mefloquine. Although treatment failure in malaria usually results from poor compliance, inadequate dosing, pharmacokinetic factors or resistance, some infections will recrudesce when none of these factors operates. How parasites persist despite apparently adequate antimalarial treatment remains unresolved.

Factors predicting mefloquine treatment failure in malaria

Factors predicting mefloquine treatment failure in malaria

Acute renal failure in malaria and some febrile and other illnesses.

(1987). Acute renal failure in malaria and some febrile and other illnesses. Annals of Tropical Medicine & Parasitology: Vol. 81, No. 5, pp. 561-566.