Partial exchange transfusion in the treatment of severe falciparum malaria.

BACKGROUND: Exchange transfusion as an adjunct to the treatment of severe falciparum malaria has been widely recommended, although there is no well-designed clinical trial to prove its efficacy. The amount of compatible blood required for total exchange is rarely available in areas endemic for malaria and the risks of the procedure including transfusion-related infections are high. METHODS: Partial transfusion with four units of blood was given to a patient with severe falciparum malaria (80% parasitaemia) whose condition deteriorated on conventional treatment with intravenous quinine. RESULTS: This brought about prompt clinical improvement and reduction in parasitaemia. CONCLUSION: Partial transfusion with one or two litres of blood is a promising and viable alternative to total exchange transfusion.

Cryptococcal meningitis in AIDS--need for early diagnosis.

Cryptococcal meningitis is the most common opportunistic fungal infection in patients with Acquired Immunodeficiency Syndrome (AIDS) contributing to the increased morbidity and mortality. This important infection in AIDS seems to be under diagnosed in India. We discuss the clinical features, laboratory diagnosis and therapy of seven cases of cryptococcal meningitis detected in our hospital. Diagnosis was established in all cases by identification of the fungus in cerebrospinal fluid (CSF) by India Ink preparation and positive fungal culture in CSF and/or Blood. Six patients were treated with Amphotericin B and Flucytosine. Two were cured and have not relapsed on suppressive therapy. Two died during treatment. Two were lost to follow up. All the three patients who died had positive fungal culture in blood and CSF. Presence of Cryptococcemia in Cryptococcal meningitis is an indicator of poor prognosis. A high index of clinical suspicion and routine mycological surveillance essential to identify this infection.