Discovery Could Lead to New Malaria Treatments

A new groundbreaking discovery about cerebral malaria published in The New England Journal of Medicine could change the landscape of treatment for the lethal disease.

Malaria has been around for centuries but the reason why the deadliest form of the disease kills children has remained a mystery—until now.

“In children with cerebral malaria, massively increased brain volume (brain swelling) is strongly tied to a fatal outcome,” says lead investigator Terrie Taylor, DO, of Michigan State University.
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One of the most common causes of death from the disease, cerebral malaria occurs when blood cells containing the Plasmodium parasite block blood vessels to the brain, which can cause inflammation and damage.

She explains that current treatments, such as anti-malarial drugs, artesunate, quinine, and quinidine, target the malaria parasite and various complications of the disease, such as anemia, seizures, and fever. 

“This new discovery allows us to focus on brain swelling—its causes and consequences—as the target for additional treatment,” Taylor says.

She and her colleagues used magnetic resonance imaging (MRI) in Malawi to investigate the role of brain swelling in the pathogenesis of fatal cerebral malaria in African children.

The team studied 168 children with cerebral malaria, performed detailed clinical observation, and obtained MRI scans on admission and daily thereafter while coma persisted.

In all, 25 of the children died from cerebral malaria—84% of whom had evidence of severe brain swelling on MRI at admission.

Only 39 of the 143 who survived showed evidence of severe brain swelling on MRI. And in those survivors who did initially present with brain swelling, serial MRI scans showed evidence of decreasing brain volume.

Next, Taylor and her colleagues hope to identify the cause of the swelling so that they can develop more targeted treatments.

They also hope to find interventions to combat the outcome of brain swelling, respiratory arrest.

“Since the brain swelling resolves in 1 to 2 days in children who survive, we would like to test the hypothesis that ventilatory support will, in effect, help to tide children over the most vulnerable period,” Taylor says.

—Colleen Mullarkey

Reference

Seydel KB, Kampondeni SD, Valim C, Potchen MJ, Milner DA, Muwalo FW, et al. Brain swelling and death in children with cerebral malaria. N Engl J Med. 2015 Mar 19;372:1126-37.