A case of successfully treated acute respiratory distress syndrome complicating Plasmodium falciparum malaria

Experimental malaria-associated acute respiratory distress syndrome is dependent on the parasite-host combination and coincides with normocyte invasion

Background

Malaria-associated acute respiratory distress syndrome (MA-ARDS) is a complication of malaria with a lethality rate of up to 80% despite anti-malarial treatment. It is characterized by a vast infiltration of leukocytes, microhaemorrhages and vasogenic oedema in the lungs. Previously, a mouse model for MA-ARDS was developed by infection of C57BL/6 mice with the Edinburgh line NK65-E of Plasmodium berghei.

Results

Here, both host and parasite factors were demonstrated to play crucial roles in the development and severity of lung pathology. In particular, the genetic constitution of the host was an important determinant in the development of MA-ARDS. Both male and female C57BL/6, but not BALB/c, mice developed MA-ARDS when infected with P. berghei NK65-E. However, the New York line of P. berghei NK65 (NK65-NY) did not induce demonstrable MA-ARDS, despite its accumulation in the lungs and fat tissue to a similar or even higher extent as P. berghei NK65-E. These two commonly used lines of P. berghei differ in their red blood cell preference. P. berghei NK65-NY showed a stronger predilection for reticulocytes than P. berghei NK65-E and this appeared to be associated with a lower pathogenicity in the lungs. The pulmonary pathology in the C57BL/6/P. berghei NK65-E model was more pronounced than in the model with infection of DBA/2 mice with P. berghei strain ANKA. The transient lung pathology in DBA/2 mice infected with P. berghei ANKA coincided with the infection phase in which parasites mainly infected normocytes. This phase was followed by a less pathogenic phase in which P. berghei ANKA mainly infected reticulocytes.

Conclusions

The propensity of mice to develop MA-ARDS during P. berghei infection depends on both host and parasite factors and appears to correlate with RBC preference. These data provide insights in induction of MA-ARDS and may guide the choice of different mouse-parasite combinations to study lung pathology.

Complicated falciparum Malaria in western Maharashtra

Background:

Complicated falciparum malaria remains a major cause of morbidity and mortality worldwide. Plasmodium falciparum malaria is a syndrome and a disease of protean clinical manifestations. All cases of falciparum malaria are potentially severe and life threatening, especially when managed inappropriately.

Aim:

The aim of the present study is to study clinical presentation and complications of patients with complicated P. falciparum malaria and its outcome.

Settings and Design:

This was retrospective observational study, conducted at tertiary care center in western Maharashtra from January 2011 to December 2011.

Materials and Methods:

Total 47 patients fulfilling criterion of complicated malaria due to P. falciparum who presented with fever having positive trophozoites of P. falciparum in blood smear were included in this study. Statistical analysis was done by EPI Info 6 statistical software.

Results and Conclusion:

A total 47 patients had smear positive complicated P. falciparum malaria with 39 were male and 8 were female patients. Total three (6.38%) patients had hypoglycemia at the time of admission. Total 29 (61.70%) patients had jaundice of which 20 were with anemia. Total 22 (46.80%) had anemia of which 20 were with jaundice. Total 6 (12.76%) had cerebral malaria, 6 (12.76%) had acute renal failure (ARF), 5 (10.63%) had acute respiratory distress syndrome (ARDS) and 1 (2.12%) had thrombocytopenia. Total 26 patients had single complication in the form of cerebral malaria 6 (12.76%), jaundice 9 (19.14%), ARF 5 (10.63%), ARDS 4 (8.51%) and anemia 2 (4.25%). Total 20 patients had two complications in the form of jaundice with anemia 20 (42.55%). One (2.12%) patient had four complications in the form of cerebral malaria with ARF with ARDS with thrombocytopenia with 100% mortality. Overall case fatality rate was 10.63% (5/47). The case fatality rate for isolated ARDS was 50% (2/4), with ARF was 20% (1/5) and with cerebral malaria it was 16.66% (1/6). Case fatality rate was highest in patients with ARDS compared to ARF and cerebral malaria with ‘P’ = 0.0221.

Conclusions:

In present study most common presentation was jaundice and anemia. Cerebral malaria, ARF and ARDS were uncommon presentation. Overall case fatality rate of complicated P. falciparum malaria was 10.63%. The case fatality rate was highest with multi-organ dysfunction (100%). This study highlights the significant burden of P. falciparum complicated malaria with isolated complication like ARDS with high mortality rate of 50% in present population.