Severe and Cerebral Malaria Investigated Through Host Metabolomics

Inclusion Criteria

• •Severe/Cerebral Malaria:
• •Any P. falciparum parasitaemia detected by asexual stages on a peripheral blood-slide or a positive rapid diagnostic test in combination with one or more Modified WHO Criteria for Severe Malaria (Hien et al, 1996)
• •\< 24 hours after treatment commencement with either parenteral artemisinin or quinine
• •Age \> 12 years
• •Full informed written consent obtained
• •Uncomplicated malaria:
• •Any level of Plasmodium parasitaemia, detected by asexual stages on a peripheral blood-slide or a positive rapid diagnostic test without any of the complications of severe malaria stated above.
• •Age \> 12 years
• •Full informed written consent obtained
• •Sepsis:
• •Clinical signs of infection in combination with any two of the following signs:
• •1. Heart rate \> 90 beats per minute;
• •2. Respiratory rate \> 20 breaths per minute, a PaCO2 of \< 32 mmHg, or the use of mechanical ventilation for an acute respiratory process;
• •3. Tympanic temperature \> 38°C or \< 36 °C;
• •4. White-cell count of \> 12x109/L or \< 4x109/L, or a differential count showing 10% immature neutrophils ;
• •Negative peripheral blood slide for any stages of malaria parasites or a negative rapid diagnostic test for falciparum and vivax malaria
• •\[As bacterial culture is not routinely available at the study site, positivity of cultures is not required\]
• •Age \> 12 years
• •Full informed written consent obtained
• •Acidosis:
• •Clinical suspicion of metabolic acidosis in combination with any of the following:
• •1. Peripheral venous bicarbonate \< 15 mmol/L
• •2. Peripheral venous base excess \< -3 mmol/L
• •Age \> 12 years
• •Full informed written consent obtained
• •Encephalitis:
• •GCS \< 11/15
• •Documented fever \> 38°C
• •Onset of symptoms \< 2 weeks, with an indication a lumbar puncture as part of the diagnostic work up
• •Negative peripheral blood slide for any stages of malaria parasites or a negative rapid diagnostic test for falciparum and vivax malaria
• •Age \> 12 years
• •Full informed written consent obtained
• •Healthy volunteers:
• •No chronic or acute disease
• •No fever in the past 2 weeks
• •Age \> 16 years
• •Full informed written consent obtained