Automated exchange transfusion for life-threatening plasmodium falciparum malaria—Lessons relating to prophylaxis and treatment

We report a case of traveller to Kenya who contracted severe plasmodium falciparum malaria complicated by disseminated intravascular coagulation and acute renal failure. She had taken no antimalarial prophylaxis in view of concerns in the media regarding the adverse effects of melloquine. There was...

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Bibliographic Details
Published in:The Journal of infection 1999-11, Vol.39 (3), p.231-233
Main Authors: Mainwaring, C.J., Leach, M.J., Nayak, N., Green, S.T., Jones, D.A., Winfield, D.A.
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Exchange Transfusion, Whole Blood
Female
Human protozoal diseases
Humans
Infectious diseases
Malaria
Malaria, Falciparum - prevention & control
Malaria, Falciparum - therapy
Medical sciences
mefloquine
Mefloquine - therapeutic use
parasitemia
Parasitemia - therapy
Parasitic diseases
Plasmodium falciparum
Protozoal diseases
quinine
Travel
Tropical medicine
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Summary:We report a case of traveller to Kenya who contracted severe plasmodium falciparum malaria complicated by disseminated intravascular coagulation and acute renal failure. She had taken no antimalarial prophylaxis in view of concerns in the media regarding the adverse effects of melloquine. There was a protracted delay before the diagnosis of malaria was made. Clinical recovery occurred following treatment with intravenous quinine, haernofiltration and manual/automated red-cell exchange transfusions. Automated red-cell exchange transfusion resulted in a marked decrease in the parasitaemia, before a response to quinine therapy would have been anticipated, leading to a successful outcome thereafter. In conjunction with other groups we therefore feel that exchange transfusions should be considered in seriously ill patients with falciparum malaria, multiorgan complications and parasitaemias greater than 10%.
ISSN:0163-4453
1532-2742
DOI:10.1016/S0163-4453(99)90055-5