The fluid management of adults with severe malaria

Fluid resuscitation has long been considered a key intervention in the treatment of adults with severe falciparum malaria. Profound hypovolemia is common in these patients and has the potential to exacerbate the acidosis and acute kidney injury that are independent predictors of death. However, new microvascular imaging techniques have shown that disease severity correlates more strongly with obstruction of the microcirculation by parasitized erythrocytes - a process termed sequestration. Fluid loading has little effect on sequestration and increases the risk of complications, particularly pulmonary edema, a condition that can develop suddenly and unpredictably and that is frequently fatal in this population. Accordingly, even if a patient is clinically hypovolemic, if there is an adequate blood pressure and urine output, there may be little advantage in infusing intravenous fluid beyond a maintenance rate of 1 to 2 mL/kg per hour. The optimal agent for fluid resuscitation remains uncertain; significant anemia requires blood transfusion, but colloid solutions may be associated with harm and should be avoided. The preferred crystalloid is unclear, although the use of balanced solutions requires investigation. There are fewer data to guide the fluid management of severe vivax and knowlesi malaria, although a similar conservative strategy would appear prudent.
Source: Critical Care - Category: Intensive Care Authors: Source Type: research

Related Links:

Conclusions Nucleoside hydrolases are vital enzymes for the replication of Leishmania, conserved phylogenetic marker of the genus and strong-specific immunogens. We demonstrated that NH36 is an excellent target for chemotherapy of visceral leishmaniasis. Searching for the most immunogenic fraction of promastigotes of Leishmania we described the FML antigen of L. (L.) donovani, that has as its main component, the NH36 Nucleoside hydrolase. We developed second–generation vaccines with the FML and the NH36 native antigens, and with the NH36 recombinant protein. In addition, we obtained a third generation vaccine based ...
Source: Frontiers in Immunology - Category: Allergy & Immunology Source Type: research
Most countries in Sub ‐Saharan Africa (SSA) are either low‐income or low‐middle income countries, that is countries whose gross national income per capita is $995 (USD) or less or $996–3895, respectively. Added to this, they have very few health care professionals specifically trained in transfusion medicine and are the countries whose populations have a high prevalence of transfusion‐transmissible agents (especially HIV, hepatitis B and malaria) and whose patients (women haemorrhaging at birth, men in motor vehicle or motorcycle accidents, children with malaria or sickle cell anaemia) are often in urgent nee...
Source: ISBT Science Series - Category: Hematology Authors: Tags: Congress Review Source Type: research
Conclusion: Early presentation will significantly reduce blood transfusions, prolonged admission and death in children with severe malaria.
Source: Nigerian Journal of Clinical Practice - Category: Rural Health Authors: Source Type: research
Abstract Autoimmune haemolytic anaemia due to malaria or following its treatment with artesunate is rare. A child presented with severe anaemia after being treated with artesunate for P. vivax malaria. Blood transfusion was difficult as cross-matching showed major incompatibility; group O negative blood under the cover of steroids was transfused. Oral steroids were given for six weeks. The patient made a complete recovery. PMID: 30293518 [PubMed - as supplied by publisher]
Source: Tropical Doctor - Category: Tropical Medicine Authors: Tags: Trop Doct Source Type: research
Hydroxyurea treatment is recommended for children with sickle cell anemia (SCA) living in high-resource malaria-free regions, but its safety and efficacy in malaria-endemic sub-Saharan Africa, where the greatest sickle-cell burden exists, remain unknown. In vitro studies suggest hydroxyurea could increase malaria severity, and hydroxyurea-associated neutropenia could worsen infections. NOHARM (Novel use Of Hydroxyurea in an African Region with Malaria) was a randomized, double-blinded, placebo-controlled trial conducted in malaria-endemic Uganda, comparing hydroxyurea to placebo at 20 ± 2.5 mg/kg per day for 12 mont...
Source: Blood - Category: Hematology Authors: Tags: Pediatric Hematology, Sickle Cell Disease, Plenary Papers, Free Research Articles, Red Cells, Iron, and Erythropoiesis, Clinical Trials and Observations Source Type: research
Publication date: Available online 21 November 2017 Source:African Journal of Emergency Medicine Author(s): Julius Nteziyaremye, George Paasi, Kathy Burgoine, Jaffer Sadiq Balyejjusa, Crispus Tegu, Peter Olupot-Olupot Paediatric shock is still a common emergency of public health importance with an estimated 400,000–500,000 reported cases annually. Mortality due to paediatric shock has varied over the years. Data in 1980s show that mortality rates due to septic shock in children were over 50%; but by the end of the year 2000 data indicated that though a marked decline in mortality rates had been achieved, it had stag...
Source: African Journal of Emergency Medicine - Category: Emergency Medicine Source Type: research
Summary The World Health Organization recommends universal iron supplementation of 30–60 mg/day in pregnancy but coverage is low in most countries. Its efficacy is uncertain, however, and there has been a vigorous debate in the last decade about its safety, particularly in areas with a high burden of malaria and other infectious diseases. We reviewed the evidence on the safety and efficacy of antenatal iron supplementation in low‐income countries. We found no evidence that daily supplementation at a dose of 60 mg leads to increased maternal Plasmodium infection risk. On the other hand, recent meta‐analy...
Source: British Journal of Haematology - Category: Hematology Authors: Tags: Review Source Type: research
This article examines delays in accessing blood and outcomes in transfused children in Kenyan hospitals. Children admitted with nonsurgical conditions in 10 Kenyan county hospitals participating in the Clinical Information Network who had blood transfusion ordered from September 2013 to March 2016 were studied. The delay in blood transfusion was calculated from the date when blood transfusion was prescribed to date of actual transfusion. Five percent (2,875/53,174) of admissions had blood transfusion ordered. Approximately half (45%, 1,295/2,875) of children who had blood transfusion ordered at admission had a documented hemoglobin
Source: The American Journal of Tropical Medicine and Hygiene - Category: Tropical Medicine Authors: Tags: Am J Trop Med Hyg Source Type: research
Mepron, a thick liquid antimicrobial drug used to treat Babesia and malaria, as well as a fungal infection called Pneumocystitis carinii. In 2011, the United Kingdom stopped requiring that dogs brought into the country be inspected for ticks. Earlier this year, several dogs tested positive for babesia, a malaria-like disease transmitted to ticks that previously had only been found in foreign. These dogs had never left the U.K. While babesiosis is a new worry to U.K. dog owners, it's been a threat to human beings for years -- it just hasn't become a health-scare-of-the-week like Zika, West Nile, avian and swine flu. Most...
Source: Healthy Living - The Huffington Post - Category: Consumer Health News Source Type: news
From about 1880 to 1920, a culture of medical experimentation promoted blood transfusion as a therapy for severe anemia in Europe, which was applied in German East Africa in 1892 for a case of blackwater fever, a complication of malaria afflicting mainly Europeans. This first case of blood transfusion in Africa, in which an African's blood was transfused into a German official, complicates the dominant narrative that blood transfusions in Africa came only after World War I. Medical researchers moreover experimented with blood serum therapies on human and animal subjects in Europe and Africa, injecting blood of different sp...
Source: Journal of the History of Medicine and Allied Sciences - Category: History of Medicine Authors: Tags: Articles Source Type: research
More News: Anemia | Blood Transusion | Intensive Care | Malaria | Parasitology | Urology & Nephrology