Publication: Brain swelling and mannitol therapy in adult cerebral malaria: A randomized trial
1
Issued Date
2011-08-15
Resource Type
ISSN
15376591
10584838
10584838
Other identifier(s)
2-s2.0-79961241467
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical Infectious Diseases. Vol.53, No.4 (2011), 349-355
Suggested Citation
Sanjib Mohanty, Saroj Kanti Mishra, Rajyabardhan Patnaik, Anil Kumar Dutt, Sudhir Pradhan, Bhabanisankar Das, Jayakrushna Patnaik, Akshaya Kumar Mohanty, Sue J. Lee, Arjen M. Dondorp Brain swelling and mannitol therapy in adult cerebral malaria: A randomized trial. Clinical Infectious Diseases. Vol.53, No.4 (2011), 349-355. doi:10.1093/cid/cir405 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/12378
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Brain swelling and mannitol therapy in adult cerebral malaria: A randomized trial
Other Contributor(s)
Abstract
Background. Coma is a frequent presentation of severe malaria in adults and an important cause of death. Therole of cerebral swelling in its pathogenesis, and the possible benefit of intravenous mannitol therapy to treat this, is uncertain. Methods. A computed tomographic (CT) scan of the cerebrum and lumbar puncture with measurement of cerebrospinal fluid (CSF) pressure were performed on admission for 126 consecutive adult Indian patients with cerebral malaria. Patients with brain swelling on CT scan were randomized to adjunctive treatment with intravenous mannitol (1.5 g/kg followed by 0.5 g/kg every 8 hours; n = 30) or no adjunctive therapy (n = 31). Results. On CT scan 80 (63%) of 126 patients had cerebral swelling, of whom 36 (29%) had moderate or severe swelling. Extent of brain swelling was not related to coma depth or mortality. CSF pressures were elevated (≥200 mm H 2 O) in 43 (36%) of 120 patients and correlated with CT scan findings (P for trend = .001). Mortality with mannitol therapy was 9 (30%) of 30 versus 4 (13%) of 31 without adjunctive therapy (hazard ratio, 2.4 [95% confidence interval, 0.8-7.3]; P = .11). Median coma recovery time was 90 hours (range, 22-380 hours) with mannitol versus 32 hours (range, 5-168 hours) without (P = .02). Conclusions. Brain swelling on CT scan is a common finding in adult patients with cerebral malaria but is not related to coma depth or survival. Mannitol therapy as adjunctive treatment for brain swelling in adult cerebral malaria prolongs coma duration and may be harmful. - The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.