lumefantrine and Respiratory-Distress-Syndrome

Plasmodium Vivax malaria is generally considered as a benign self-limiting illness and is less often associated with more severe disease and complications. Amongst these, acute respiratory distress syndrome (ARDS) is a particularly rare complication. The few cases reported describe the onset of ARDS after initiation of anti-malarial therapy as a post inflammatory response. Here we report the case of a 45 year old male who was a victim of severe Plasmodium vivax malaria culminating into ARDS, prior to the initiation of anti-malarial therapy. He was treated with invasive ventilation and anti-malarial therapy and made a complete and uneventful recovery.

Topics: Adult; Antimalarials; Artemether; Artemisinins; Ethanolamines; Fluorenes; Humans; Lumefantrine; Malaria, Vivax; Male; Radiography, Thoracic; Respiration, Artificial; Respiratory Distress Syndrome

The simian parasite Plasmodium knowlesi causes severe human malaria; the optimal treatment remains unknown. We describe the clinical features, disease spectrum, and response to antimalarial chemotherapy, including artemether-lumefantrine and artesunate, in patients with P. knowlesi malaria diagnosed by PCR during December 2007-November 2009 at a tertiary care hospital in Sabah, Malaysia. Fifty-six patients had PCR-confirmed P. knowlesi monoinfection and clinical records available for review. Twenty-two (39%) had severe malaria; of these, 6 (27%) died. Thirteen (59%) had respiratory distress; 12 (55%), acute renal failure; and 12, shock. None experienced coma. Patients with uncomplicated disease received chloroquine, quinine, or artemether-lumefantrine, and those with severe disease received intravenous quinine or artesunate. Parasite clearance times were 1-2 days shorter with either artemether-lumefantrine or artesunate treatment. P. knowlesi is a major cause of severe and fatal malaria in Sabah. Artemisinin derivatives rapidly clear parasitemia and are efficacious in treating uncomplicated and severe knowlesi malaria.

Topics: Acute Kidney Injury; Adult; Antimalarials; Artemether; Artemisinins; Artesunate; Chloroquine; Ethanolamines; Female; Fluorenes; Hospitals, Urban; Humans; Lumefantrine; Malaria; Malaysia; Microscopy; Middle Aged; Parasitemia; Patient Selection; Plasmodium knowlesi; Polymerase Chain Reaction; Quinine; Respiratory Distress Syndrome; Severity of Illness Index; Shock; Survival Rate