The blood purification therapy-based strategy effectively rescued the severe falciparum malaria patient experiencing cytokine storm driven MODS

Ying Sun¹Xi Huang¹Bao Hong²Jinyuan Song¹Ying Lu²Jindi Ma¹Xiaojing Wang²Wenqing Hu²Yimin Zhang¹Hua Xuan^3*

• ¹The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
• ²Haining People's Hospital, Haining, China
• ³First Hospital of Jiaxing, Jiaxing, China

The mortality of severe falciparum malaria is high in which cytokine storm (CS) plays an important role and the standard effective therapy strategy remained unclear. A 63-year-old severe falciparum malaria patient with CS was treated with therapeutic plasma exchange (TPE) combined continuous veno-venous hemodiafiltration (CVVHDF) on the onset of multiple organ dysfunction syndrome (MODS). All the clinical data during hospitalization period were collected from the electronic medical records, and the dynamic changes of serum cytokines were recorded simultaneously. We searched databases such as PubMed, and summarized case reports on the use of blood purification as an adjuvant therapy in severe Plasmodium infection patients. After first session of TPE+CVVHDF therapy, aberrant elevated cytokines especially interleukin-6 and interferon gamma decreased sharply from 729.65pg/ml to 26.42pg/ml and 170.38pg/ml to 42.47pg/ml respectively. Plasmodium were controlled and A Physiology and Chronic Health Evaluation II score, ratio of neutrophil to lymphocyte,procalcitonin and C reactive protein ameliorated with the gradually recovering from MODS. Most of pro-inflammation or anti-inflammation cytokines showed positive relationship trends to parasite count in recovering stage. In the summarized case reports, a total of 29 patients received antimalarial regimens with blood purification as an adjuvant therapy, in addition to 6 small cohort studies. 19 patients who received TPE or blood purification treatment including TPE all exhibited systemic inflammatory symptoms or developed MODS in the early stage of infection, and all these cases eventually had a good prognosis. TPE+CVVHDF based strategy provided a promising CS targeting vision in rescuing severe falciparum malaria patients with MODS.