Intravenous immunoglobulin in the treatment of paediatric cerebral malaria

SUMMARY Hyperimmune globulin can inhibit and reverse the cytoadherence between Piasmodium falciparum‐ infected erythrocytes and melanoma cells in vitro. Cytoadherence is believed to mediate disease in cerebral malaria. Therefore we studied the efficacy of i.v. immunoglobulin, purified from the plasm...

Full description

Saved in:
Bibliographic Details
Published in:Clinical and experimental immunology 1992-12, Vol.90 (3), p.357-362
Main Authors: TAYLOR, T. E., MOLYNEUX, M. E., WIRtMA, J. J., BORGSTEIN, A., GOLDRtNG, J. D., HOMMEL, M.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cell Adhesion
cerebral malaria
Child
Child, Preschool
Complement System Proteins - analysis
Erythrocytes - parasitology
Female
Human protozoal diseases
Humans
Immunoglobulins, Intravenous - therapeutic use
Immunology
Immunotherapy
Infant
Infectious diseases
intravenous immunoglobulins
Life Sciences & Biomedicine
Malaria
Malaria, Cerebral - blood
Malaria, Cerebral - pathology
Malaria, Cerebral - therapy
Malaria, Falciparum - blood
Malaria, Falciparum - pathology
Malaria, Falciparum - therapy
Male
Medical sciences
Parasitic diseases
Protozoal diseases
randomized controlled trials
Science & Technology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:SUMMARY Hyperimmune globulin can inhibit and reverse the cytoadherence between Piasmodium falciparum‐ infected erythrocytes and melanoma cells in vitro. Cytoadherence is believed to mediate disease in cerebral malaria. Therefore we studied the efficacy of i.v. immunoglobulin, purified from the plasma of local semi‐immune blood donors, as an adjunct to standard treatment for cerebral malaria in Malawian children. The immunoglobulin preparation (IFAT antimalarial antibody titre 1:5120) recognized erythrocyte‐associated antigens of each of 22 Malawian P. falciparum isolates studied, and reversed binding of Malawian isolates to melanoma cells. Immunoglobulin did not reverse binding to human monocytes or to cells of the human hystiocytic lymphoma cell line U937. Thirty‐one children with P. falciparum parasitaemia and unrousable coma were enrolled. All were treated with i.v. quinine dihydrochloride; in addition patients were randomized to receive either immunoglobulin (400 mg/kg by i.v. infusion over 3 h) or placebo (albumen and sucrose by similar infusion) in a double blind trial with sequential analysis. Of 16 patients receiving immunoglobulin, five (31%) died and five survivors had neurological sequelae. Of 15 patients receiving placebo, one (7%) died and two had sequelae. Parasite clearance, fever clearance and coma resolution times in survivors were similar in the two groups. Although the difference in outcome between the two groups was not significant, the trial was stopped because immunoglobulin was demonstrated not to be superior to placebo.
ISSN:0009-9104
1365-2249
DOI:10.1111/j.1365-2249.1992.tb05851.x