Adjunctive therapy for cerebral malaria and other severe forms of Plasmodium falciparum malaria.
Severe malaria due to Plasmodium falciparum causes more than 800,000 deaths every year. Primary therapy with quinine or artesunate is generally effective in controlling P. falciparum parasitemia, but mortality from cerebral malaria and other forms of severe malaria remains unacceptably high. Long-term cognitive impairment is also common in children with cerebral malaria. Of the numerous adjunctive therapies for cerebral malaria and severe malaria studied over the past five decades, only one (albumin) was associated with a reduction in mortality. In this article, we review past and ongoing studies of adjunctive therapy, and examine the evidence of efficacy for newer therapies, including inhibitors of cytoadherence (e.g., levamisole), immune modulators (e.g., rosiglitazone), agents that increase nitric oxide levels (e.g., arginine) and neuroprotective agents (e.g., erythropoietin).
John
Chandy C
CC
Center for Global Pediatrics, 717 Delaware Street SE, Room 363, Minneapolis, MN 55455, USA. ccj@umn.edu
Kutamba
Elizabeth
E
Mugarura
Keith
K
Opoka
Robert O
RO
D000962:Antimalarials / Q000627:therapeutic use*; D001120:Arginine / Q000627:therapeutic use; D004921:Erythropoietin / Q000627:therapeutic use; D006801:Humans; D007978:Levamisole / Q000627:therapeutic use; D016779:Malaria, Cerebral / Q000188:drug therapy*; D016778:Malaria, Falciparum / Q000188:drug therapy*; D010963:Plasmodium falciparum; D016032:Randomized Controlled Trials as Topic; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000627:therapeutic use
D000962:Antimalarials; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D004921:Erythropoietin; D007978:Levamisole; D001120:Arginine
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