Renal and systemic hemodynamics, in falciparum malaria.

Renal and systemic hemodynamics, plasma arginine vasopressin, plasma renin activity, plasma norepinephrine, blood volume and water loading test were studied in 10 patients with falciparum malaria without renal failure. Six patients responded to water load normally, while 4 patients had a decreased response to water load. The patients with a normal water load response had normal renal and systemic hemodynamics and a normal hormonal profile. The patients with a decreased response to water load had hyponatremia, hypervolemia, high cardiac index, low systemic vascular resistance, high plasma arginine vasopressin, high plasma renin activity, high plasma norepinephrine, low creatinine and p-aminohippurate clearances, low urine sodium and high urine osmolality. They had a lower mean arterial pressure during the acute phase of the disease than during the recovery phase. The findings suggest that a decreased response to water load is due to peripheral vasodilatation which results in a decreased effective blood volume leading to the release of vasopressin and norepinephrine, increased renin activity and decreased renal hemodynamics.

Lightning injury: a case report.

A 40-year-old Thai male was struck by lightning while he was riding his motorcycle during a day of gathering clouds and threatening rain. There were third degree burns around the mastoid areas corresponding to the metal arms of the spectacles, also around the neck where a silver chain with pendant (Buddha image) hung, as well as a full thickness vertical lesion down the center of the chest and abdomen where the zip of the jacket made its mark. Fern-like skin erythema was also seen around the later wound. These are stigmas of lightning skin injuries and the patient survived with no memory of the event.

Furosemide and dopamine in malarial acute renal failure.

The effects of furosemide and furosemide with dopamine on renal function were studied in 23 patients with acute renal failure due to falciparum malaria whose serum creatinine ranged from 230 to 947 mumol/l. Furosemide given intravenously at the dosage of 200 mg 6 hourly for a period of 4 days did not alter the clinical course of renal failure. Intravenous administration of furosemide (200 mg 6 hourly) with dopamine (1 microgram/kg/min) for 4 days increased creatinine clearance and arrested the progress of renal failure when the serum creatinine was less than 400 mumol/l, but failed to alter the course of renal failure when the serum creatinine exceeded 600 mumol/l.

Complement changes in falciparum malaria infection.

Complement profiles were sequentially studied in 183 Thai adults infected with Plasmodium falciparum. On the first day of admission, CH50, C1q, C4 and C3 were low in 65%, 8%, 19% and 62% of cases, respectively. All patients with low C1q or C4 also had low C3 and CH50. Simultaneous reduction of C1q, C4, C3 and CH50 were found in 10 instances. Factor B was not reduced in any of the patients indicating that only the classical pathway is activated during acute falciparum malaria infection. The incidence and the degree of hypocomplementaemia were higher in patients with cerebral, renal and hepatic complications although significant difference was seen only for C3. After 3-4 days of effective anti-malarial treatment, normalization of C1q and C4 was found in almost all instances whereas C3 and CH50 remained low in 27% and 54% of the cases, respectively. Normalization of C3 was achieved at 4 weeks after discharge while low CH50 still persisted. The reasons for the persistently low CH50 remain unknown.

Hemolytic uremic syndrome in leptospirosis bataviae.

Hemolytic uremic syndrome was observed in a 46-year-old man who had leptospirosis. Renal failure was severe with a prolonged clinical course. Despite clinical recovery there was residual renal damage indicated by mildly elevated serum creatinine. This is the first report of hemolytic uremic syndrome in leptospirosis.

Autoantibodies in falciparum malaria: a sequential study in 183 Thai patients.

Various autoantibodies were sequentially studied in 183 consecutive Thai adults infected with Plasmodium falciparum. On the first day of admission, 31.1% of the patients had positive fluorescent anti-nuclear antibodies (FANA) and 16.9% had positive smooth muscle antibodies (SMA). The incidences of positive FANA and SMA rose progressively with times when the patients returned for the 2 and 4 week follow-ups after discharge, although most of their malaria was cured. The majority of the positive FANA and SMA titres lay between 1:20 and 1:160. The positivity of the FANA and SMA did not correlate with the complications of malaria, nor the initial serum IgG or IgA levels. However, they significantly correlated with the initial hyper-IgM. More interestingly, almost all of the positive FANA were of the speckled type of nuclear staining. The antigen specificity of the speckled FANA were found not to be the double stranded DNA or the extractable nuclear antigens. The polyclonal B cell activation in active malarial infection was postulated.