Saturday, April 28, 2007

Saturday April 28, 2007
Treating malaria (and other parasites) with Xigris - Drotrecogin alfa (activated) ?


While working on our pearl
Treating HIT with Xigris? , (April 24, 2007), our team came across 2 interesting case reports, which should be of great interest to our friends from countries where multi-organ failure from malaria and other parasites is still an everyday occurrence. For full length discussion, click on reference # 2 below.

1. ".... We describe the care of a 61-year-old man who developed multi-organ failure secondary to severe falciparum malaria infection with parasitaemia levels of 40%. Included in his care were an exchange blood transfusion and an infusion of Drotrecogin alfa (activated). Within hours of starting the infusion of Drotrecogin alfa (activated), the patient's clinical condition stopped deteriorating. Steady improvement followed with weaning from ventilatory assistance on day 14 post admission. The patient made a full recovery and was discharged home following rehabilitation....Drotrecogin alfa (activated) may be a useful treatment in patients with multi-organ failure resulting from severe malaria 1.

2.
"....The patient was a 25-year old male admitted in the Respiratory Intensive Care Unit with fever, haemolysis, acute renal failure, hepatitis, acute lung injury (ALI) and altered sensorium. A syndromic evaluation was done and investigations revealed falciparum parasitaemia. He was treated with parenteral artesunate, ceftriaxone and doxycycline, and adjunctive therapies as for severe sepsis. Infusion of activated protein C was started 20 hours after onset of organ dysfunction, and intensive haemodialysis was instituted. Over the next four days the patient became afebrile with progressive resolution of ALI, renal failure and hepatitis. His Leptospira serology (requested as part of the evaluation) was reported positive on day 5. Dual infections are common and under-recognized in the tropics. Failure to treat potential co-infections may lead to poor outcomes. Acute lung injury in falciparum malaria has high mortality rates and therapy as for severe sepsis may improve survival. Adjunctive therapies, including activated protein C, cannot replace source eradication" 2.



Reference: click to get abstract

1.
Drotrecogin alfa (activated) in severe falciparum malaria. - Anaesthesia. 2006 Sep;61(9):899-902

2.
Severe sepsis due to severe falciparum malaria and leptospirosis co-infection treated with activated protein C - Malaria Journal 2007, 6:42

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