Apheresis for severe malaria complicated by cerebral malaria, acute respiratory distress syndrome, acute renal failure, and disseminated intravascular coagulation.
Malaria has become a very uncommon disease in Italy. Recently a variety of circumstances, such as travel to tropical countries as well as immigration from Asia and Africa, have combined to increase the number of malaria cases recorded annually. In this report we describe the use of red cell exchange transfusion and plasma exchange in the treatment of a patient with hyperparasitemic malaria (51% erythrocytes or more parasitized). When first observed the patient was in shock and had signs of cerebral malaria, disseminated intravascular coagulation, and acute respiratory distress syndrome, which in the following 2 days were complicated by acute renal failure. After mefloquine therapy combined with 3 red blood cell exchanges, 2 plasma exchanges, and 10 dialysis sessions over 14 days, the patient recovered completely. This case of severe malaria with multiple complications, treated with mefloquine in conjunction with both exchange transfusion and plasmapheresis, had a successful outcome and lends further support to the possible beneficial role of exchange transfusion in complicated malaria.
Lercari
G
G
Infectious Diseases Division, San Martino University Hospital, Genova, Italy.
Paganini
G
G
Malfanti
L
L
Rolla
D
D
Machi
A M
AM
Rizzo
F
F
Cannella
G
G
Valbonesi
M
M
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000209:etiology*; D000740:Anemia / Q000209:etiology; D001781:Blood Component Removal; D016913:Blood Component Transfusion; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology; D008288:Malaria / Q000150:complications / Q000628:therapy*; D016779:Malaria, Cerebral / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D012128:Respiratory Distress Syndrome / Q000209:etiology*