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The Goeckerman Regimen for the Treatment of Moderate to Severe Psoriasis
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Severe malaria: update on pathophysiology and treatment.

Josef A Brejt1, Linnie M Golightly

  • 1Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, New York, USA.

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Summary

Severe malaria, caused by Plasmodium falciparum, involves infected red blood cell sequestration and protein C pathway disruptions. Current US treatment guidelines recommend intravenous artesunate for severe malaria.

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Area of Science:

  • Infectious Diseases
  • Hematology
  • Pathophysiology

Background:

  • Malaria affects over 200 million people annually, with Plasmodium falciparum causing severe, potentially lethal disease.
  • Severe malaria can lead to neurocognitive deficits even with treatment.
  • Understanding severe malaria pathophysiology is crucial for improved patient outcomes.

Purpose of the Study:

  • To review recent advances in the pathophysiology of severe malaria.
  • To discuss current treatment recommendations for severe malaria in the United States.

Main Methods:

  • Review of recent scientific literature on severe malaria.
  • Analysis of mechanisms underlying infected red blood cell sequestration.
  • Examination of the role of the protein C/EPCR axis in severe malaria pathogenesis.

Main Results:

  • Infected red blood cell sequestration in microvasculature is key to severe malaria syndromes.
  • Interactions with EPCR disrupt coagulation and cytopreservation pathways, implicated in cerebral malaria, respiratory distress, and anemia.
  • US guidelines recommend intravenous artesunate for severe malaria, including in pregnant women and children.

Conclusions:

  • Despite advances, significant knowledge gaps remain in severe malaria pathogenesis.
  • Current antimalarials target parasites but do not prevent or ameliorate severe disease or sequelae.
  • Development of effective adjunctive therapies is needed to address severe malaria complications.