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

## TL;DR

A blood purification therapy successfully treated a severe malaria patient with a dangerous immune overreaction and organ failure.

## Contribution

Demonstrates the effectiveness of TPE+CVVHDF in managing cytokine storm and MODS in severe falciparum malaria.

## Key findings

- TPE+CVVHDF sharply reduced elevated cytokines like IL-6 and IFN-gamma in a severe malaria patient.
- The therapy helped control Plasmodium and improve organ function as indicated by clinical markers.
- Case reviews showed 19 out of 29 patients with blood purification had good outcomes despite severe symptoms.

## Abstract

The mortality of severe falciparum malaria is high, in which cytokine storm (CS) plays an important role, and the standard effective therapy strategy remains unclear.

A 63-year-old severe falciparum malaria patient with CS was treated with therapeutic plasma exchange (TPE) combined with continuous venovenous hemodiafiltration (CVVHDF) at the onset of multiple organ dysfunction syndrome (MODS). All clinical data, including symptoms, laboratory results, and treatment methods during the hospitalization period, were collected from electronic medical records, and the dynamic changes of serum cytokines were recorded simultaneously. At the same time, we searched databases such as PubMed, Web of Science, and Scopus and summarized case reports on the use of blood purification as an adjuvant therapy for patients with severe Plasmodium infection.

After the first session of TPE+CVVHDF therapy, aberrant elevated cytokines, especially interleukin-6 and interferon-gamma, decreased sharply from 729.65 to 26.42 pg/mL and 170.38 to 42.47 pg/mL, respectively. Plasmodium was controlled, and the A Physiology and Chronic Health Evaluation II score, neutrophil-to-lymphocyte ratio, procalcitonin, and C-reactive protein ameliorated as the patient gradually recovered from MODS. Most of the pro-inflammatory or anti-inflammatory cytokines showed positive relationship trends to parasite count in the recovery stage. Among the case reports of severe malaria infection that we summarized, a total of 29 patients received antimalarial regimens with blood purification as an adjuvant therapy, in addition to six small cohort studies. Of these, 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.

The TPE+CVVHDF-based strategy provided a promising CS approach in rescuing severe falciparum malaria patients with MODS.