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Infectious Disease and Foreign Travel Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Falciparum malaria is the most dangerous form of malaria. Cases are imported to Australia from Africa, Asia and Papua New Guinea, but other tropical sources include the western Pacific, Amazon basin and Oceania. Malaria is a potentially fatal infection. Survivors may experience damage to the brain, kidneys, liver, heart, gastrointestinal tract and lungs.Cerebral malaria is an abrupt onset of encephalopathy with headache that can progress rapidly to confusion, seizures and coma.Other malaria presentations include an influenza-like illness, diarrhoea and vomiting, jaundice, acute renal failure, acute respiratory distress, postural hypotension or shock, progressive anaemia and thrombocytopenia.The patient may not look ill in the first few days, but the non-immune or splenectomized patient may then deteriorate rapidly over a few hours and die.
Unexplained Fever In Neurological Disorders
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Cerebral malaria or malaria with neurological complications must always be borne in mind in a patient who has been in the tropics or who has received a blood transfusion within 3 months of the onset of the disease, and who has a neuropsychiatrie disorder associated with UEF. Malaria may produce a wide range of CNS symptoms resembling, in many ways, neurosyphilis. Altered state of consciousness, psychosis, and seizures may occur.The cerebral form is predomonantly caused by Plasmodium falciparum. This clinical form is seen often in children and decreases in frequency with aging.25 The common clinical presentation during the first-time infections (“primo-infection”) as they usually occur in Europeans, is fever with a distinct prodrome of headaches, myalgia,and anorexia. After 7 to 8 days of fever many patients complain of influenza-like symptoms. Agitation and delirium may be followed by coma and death within hours or days. Signs of meningeal irritation may be the first sign of cerebral malaria or appear later in the course.26 However, unfortunately the spinal fluid is usually normal or shows increased opening pressure with minimal changes in the CSF content.
Malaria
Published in Alisa McQueen, S. Margaret Paik, Pediatric Emergency Medicine: Illustrated Clinical Cases, 2018
The pictured blood smear demonstrates intracellular parasites within the red blood cells. Given the patient's recent travel to West Africa, malaria is the most likely diagnosis. The patient's significantly altered mental status suggests cerebral malaria. Cerebral malaria is defined by impaired consciousness, delirium, and/or seizures in the setting of known or suspected malaria infection. Without treatment, cerebral malaria is nearly always fatal.
Clinical characteristics of platelet-mediated killing circulating parasite of major human malaria
Published in Annals of Medicine, 2023
Dewu Bi, Xiaodong Huang, Lü Lin, Xike Tang, Yuexi Lu, Zhenxu Lan, Shunda Luo, Jianyan Lin, Xiaocheng Luo
Therapies with high doses of artemisinin derivatives somehow does not reduce deaths or neurological disability in the majority of cerebral malaria cases [30]. Given the parasite resistance, quinoline derivatives are even less efficient at treating severe malaria than artesunate and artemisinin derivatives [31]. However, quinoline derivatives are common rapidly schizonticidal substances, which are able to reduce the mortality and mortality and alleviate the neurological cognitive deficits in cerebral malaria patients [30]. As a result, the World Health Organization has recommended combining quinoline derivatives with artemisinin-based combination therapies (ACTs). Artemisinin and ACT partner-drug resistant parasites have spread from southeast Asia to sub-Saharan Africa and Latin America, posing serious challenges to malaria control [32–34]. The diffusion of artemisinin and ACT partner-drug resistant parasites drives an urgent investigation for novel therapies, especially cerebral malaria. Computer-aided drug design (CADD) and high-throughput screening (HTS) are the two most promising methods for developing novel treatments and could meet the urgent demand for treatment of malaria and should be used in the pharmaceutical industry [35–36].
The Impact of Interferon-γ (IFN-γ) and IFN-γ-Inducible Protein 10 (IP-10) Genes’ Polymorphism on Risk of Hepatitis C Virus–Related Liver Cirrhosis
Published in Immunological Investigations, 2022
Roba M. Talaat, Shimaa Elsharnoby, Mohamed S. Abdelkhalek, Soha Z. El-Shenawy, Samir Elmasry
Our data analysis revealed similarities of genotypes and alleles distributions of IP-10 − 1447A/G SNP in HCV cirrhotic compared to non-cirrhotic patients. Interestingly, IP-10 − 1447AA genotype and allele A are the most frequent in both groups; also AA, GG genotypes might have a risk for liver cirrhosis. Our study is the first documented study of the association between IP-10 − 1447A/G and HCV-LC risk. Tang et al. (2009) on the Chinese population reported that there is no association between IP-10 − 1447A/G and susceptibility to TB infection, with no differences in the distribution of genotypes and alleles, explaining that AG genotype and A allele were the most common in patients. In disagreement with our study, Sheikh et al. (2015) found that the GG genotype is a protective factor for TB in the Indian population. Wilson et al. (2013) revealed that AG genotype was the most frequent genotype in the Cerebral Malaria (CM) group compared to control. It might be considered a risk factor for Cerebral Malaria infection in the Indian population.
Understanding and managing the impact of the COVID-19 pandemic and lockdown on patients with epilepsy
Published in Expert Review of Neurotherapeutics, 2022
Giovanni Assenza, Lorenzo Ricci, Jacopo Lanzone, Marilisa Boscarino, Carlo Vico, Flavia Narducci, Biagio Sancetta, Vincenzo Di Lazzaro, Mario Tombini
Several clinical reports suggest an increased risk of seizure associated with chloroquine treatment [15–20]. These cases contributed to the pro-convulsant reputation of chloroquine and the consequent serious concerns about chloroquine use in PwE with SARS-COV-2 infections. However, seizures complicate the clinical course in more than 30% of children admitted to hospital with falciparum malaria[21]. They occur in over 60% of cerebral malaria cases[22] and are associated with an increased risk of death[23] and neurological sequelae[24,[25]. There are no systematic reviews that highlight a significant correlation between seizure risk and chloroquine/hydroxychloroquine therapy. However, a double-blinded randomized controlled trial on barbiturates seizure prophylaxis by Crawley and colleagues[26] showed that the occurrence of seizures in children with cerebral malaria was not correlated to the plasma level of chloroquine and its metabolites. These data support a simple indirect association between chloroquine and seizures, possibly caused by direct cerebral involvement by Plasmodium falciparum.