Arjen M. Dondorp, Can İnce, Prakaykaew Charunwatthana, Josh Hanson et al.
BACKGROUND: This study sought to describe and quantify microcirculatory changes in the mucosal surfaces of patients with severe malaria, by direct in vivo observation using orthogonal polarization spectral (OPS) imaging. METHODS: The microcirculation in the rectal mucosa of adult patients with sever...
Josh Hanson, Sue J. Lee, Sanjib Mohanty, M. Abul Faiz et al.
BACKGROUND: World Health Organization treatment guidelines recommend that adults with severe malaria be admitted to an intensive care unit (ICU). However, ICU facilities are limited in the resource-poor settings where most malaria occurs. Identification of patients at greater risk of complications m...
Katherine Plewes, Hugh W. F. Kingston, Aniruddha Ghose, Richard J. Maude et al.
Intravascular hemolysis is an intrinsic feature of severe malaria pathophysiology but the pathogenic role of cell-free hemoglobin-mediated oxidative stress in severe malaria associated acute kidney injury (AKI) is unknown. As part of a prospective observational study, enrolment plasma cell-free hemo...
Josh Hanson, Sophia WK Lam, Sanjib Mohanty, Shamshul Alam et al.
OBJECTIVE: To evaluate the efficacy and safety of liberal fluid resuscitation of adults with severe malaria. DESIGN, SETTING, PATIENTS, AND METHODS: Twenty-eight Bangladeshi and Indian adults with severe falciparum malaria received crystalloid resuscitation guided by transpulmonary thermodilution (P...
Josh Hanson, Sue J. Lee, Md Amir Hossain, Nicholas M. Anstey et al.
BACKGROUND: Microvascular obstruction and endothelial dysfunction have both been linked to tissue hypoperfusion in falciparum malaria, but their relative contributions to the disease's pathogenesis and outcome are unknown. METHODS: Microvascular blood flow was quantified in adults with severe falcip...
Richard J. Maude, Nicholas A. V. Beare, Abdullah Abu Sayeed, Christina C. Chang et al.
A specific retinopathy has been described in African children with cerebral malaria, but in adults this has not been extensively studied. Since the structure and function of the retinal vasculature greatly resembles the cerebral vasculature, study of retinal changes can reveal insights into the path...
Prakaykaew Charunwatthana, Maryam Faiz, Ronnatrai Ruangveerayut, Richard J. Maude et al.
OBJECTIVE: Markers of oxidative stress are reported to be increased in severe malaria. It has been suggested that the antioxidant N-acetylcysteine (NAC) may be beneficial in treatment. We studied the efficacy and safety of parenteral NAC as an adjunct to artesunate treatment of severe falciparum mal...
Josh Hanson, Sophia WK Lam, Kishore C Mahanta, Ritesh Pattnaik et al.
BACKGROUND: Sequestration of parasitized erythrocytes in the microcirculation is considered the central pathophysiological process in severe falciparum malaria. Hypovolemia with reduced oxygen delivery and microvascular obstruction have different implications for patient management; however, their r...
Prakaykaew Charunwatthana, Sophie Cohen, Bert‐Jan H. van den Born, Joost Meijers et al.
Severe falciparum malaria remains a major killer in tropical countries. Central in the pathophysiology is mechanical obstruction in the microcirculation caused by cytoadherence and sequestration of parasitized erythrocytes. However, the pathogenesis of many features complicating severe malaria, incl...
Katherine Plewes, Hugh W. F. Kingston, Aniruddha Ghose, Thanaporn Wattanakul et al.
Background: Acute kidney injury independently predicts mortality in falciparum malaria. It is unknown whether acetaminophen's capacity to inhibit plasma hemoglobin-mediated oxidation is renoprotective in severe malaria. Methods: This phase 2, open-label, randomized controlled trial conducted at two ...
Katherine Plewes, A. A. N. M. Royakkers, Josh Hanson, Md Mahtab Uddin Hasan et al.
BACKGROUND: Acute kidney injury (AKI) complicating severe Plasmodium falciparum malaria occurs in up to 40% of adult patients. The case fatality rate reaches 75% in the absence of renal replacement therapy (RRT). The precise pathophysiology of AKI in falciparum malaria remains unclear. Histopatholog...
Josh Hanson, Nguyen Hoan Phu, Mahtab Uddin Hasan, Prakaykaew Charunwatthana et al.
BACKGROUND: Thrombocytopenia is a common finding in adults with severe falciparum malaria, but its clinical and prognostic utility is incompletely defined. METHODS: Clinical and laboratory data from 647 adults with severe falciparum malaria were analysed retrospectively to determine the relationship...
Richard J. Maude, Frederik Barkhof, Mahtab Uddin Hassan, Aniruddha Ghose et al.
BACKGROUND: Magnetic resonance imaging (MRI) allows detailed study of structural and functional changes in the brain in patients with cerebral malaria. METHODS: In a prospective observational study in adult Bangladeshi patients with severe falciparum malaria, MRI findings in the brain were correlate...
Richard J. Maude, Gofranul Hoque, Mahtab Uddin Hasan, Abu Sayeed et al.
BACKGROUND: Early start of enteral feeding is an established treatment strategy in intubated patients in intensive care since it reduces invasive bacterial infections and length of hospital stay. There is equipoise whether early enteral feeding is also beneficial in non-intubated patients with cereb...
Richard J. Maude, Kamolrat Silamut, Katherine Plewes, Prakaykaew Charunwatthana et al.
BACKGROUND: Cytoadherence and sequestration of erythrocytes containing mature stages of Plasmodium falciparum are central to the pathogenesis of severe malaria. The oral anthelminthic drug levamisole inhibits cytoadherence in vitro and reduces sequestration of late-stage parasites in uncomplicated f...