Considerations on the use of adjunct red blood cell exchange transfusion in the treatment of severe Plasmodium falciparum malaria.
BACKGROUND
Travelers returning to the United States from malaria-endemic areas are at increased risk of a potentially fatal infection from Plasmodium falciparum, which requires prompt and aggressive treatment.


METHODS
Described is a case of a 7-year-old boy who was infected by P. falciparum while in Africa and developed features of severe infection, including hyperparasitemia, altered neurologic status, and malarial hepatitis.


RESULTS
A single automated erythrocytapheresis procedure reduced parasitemia from 14% to less than 1%. Along with intravenous quinidine, this reduced parasite level was maintained throughout the hospitalization and the patient recovered.


CONCLUSIONS
Exchange transfusion (ET) is an effective adjunct therapy to reduce the parasite load in cases of severe P. falciparum malaria. When performed in certain defined settings, the benefits can outweigh the risks of the procedure. Discussed are the medical and technical considerations on the use of adjunctive ET for severe P. falciparum infection and a review of the literature of the use of adjunct ET in the treatment of severe P. falciparum malaria.
Shelat
Suresh G
SG
Department of Pathology and Laboratory Medicine, Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19105, USA. suresh@alum.mit.edu
Lott
Jason P
JP
Braga
Matthew S
MS
D000410:Alanine Transaminase / Q000097:blood; D000962:Antimalarials / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000097:blood; D001331:Automation / Q000379:methods; D003131:Combined Modality Therapy; D003402:Creatine Kinase / Q000097:blood; D017707:Erythrocyte Transfusion / Q000379:methods*; D005078:Exchange Transfusion, Whole Blood / Q000379:methods*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood / Q000145:classification / Q000453:epidemiology / Q000628:therapy*; D018512:Parasitemia / Q000097:blood / Q000628:therapy; D011486:Protein C / Q000627:therapeutic use; D011802:Quinidine / Q000627:therapeutic use; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D005723:gamma-Glutamyltransferase / Q000097:blood
D000962:Antimalarials; D005343:Fibrinolytic Agents; D011486:Protein C; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003402:Creatine Kinase; D011802:Quinidine