title: Progression of skeletal muscle damage during treatment of severe falciparum malaria.
abstract: To assess the relationship between severity of malaria and progression of skeletal muscle damage during initial treatment, we studied 28 Thai adults with slide-positive falciparum malaria. Six had uncomplicated malaria (Group 1), 12 had severe non-cerebral malaria (Group 2) and ten had cerebral malaria (Group 3). There were no significant differences between baseline serum creatine kinase (CK) levels in the three groups (P=0.071). There was no change in serum CK during the first 48 h of treatment in Group 1 cases. In Group 2 patients, the median peak serum CK was nine times that at baseline while in Group 3, serum CK peaked at a median concentration 20 times that at presentation. In Groups 2 and 3, the peak serum CK occurred at least 24 h after presentation in more than half the patients, and was independent of intramuscular injections and convulsions during initial therapy. These longitudinal data suggest that: (i) severe falciparum malaria is associated with skeletal muscle damage that increases during initial therapy especially in patients with coma; (ii) the effect of other major treatment or infection-specific factors that are associated with muscle damage does not diminish this relationship; and (iii) cerebral malaria in combination with a high baseline and rising serum CK should pre-empt monitoring and management strategies aimed at preserving renal function including renal dialysis.
authors.affiliation: Nuffield Department of Clinical Medicine, Oxford University, John Radcliffe Hospital, Oxford OX3 9DU, Headington, UK. tdavis@cyllene.uwa.edu.au
authors.forename: T M
authors.initials: TM
authors.lastname: Davis
authors.forename: W
authors.initials: W
authors.lastname: Supanaranond
authors.forename: S
authors.initials: S
authors.lastname: Pukrittayakamee
authors.forename: P
authors.initials: P
authors.lastname: Holloway
authors.forename: P
authors.initials: P
authors.lastname: Chubb
authors.forename: N J
authors.initials: NJ
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003402:Creatine Kinase / Q000097:blood; D018450:Disease Progression; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects; D016779:Malaria, Cerebral / Q000150:complications; D016778:Malaria, Falciparum / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology; D009135:Muscular Diseases / Q000209:etiology* / Q000473:pathology
chemical_list: D003402:Creatine Kinase