Research Group Heussler (Malaria I) - Bernhard-Nocht-Institut für ...

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Clinical Department Cardiac impairment in falciparum malaria Zusammenfassung Eine Herzbeteiligung bei Malaria tropica wurde bisher als äusserst selten beschrieben. Eine Fall-Kontroll-Studie bei Europäern mit komplizierter und unkomplizierter Malaria tropica sollte diese Annahme verifizieren. Es wurden Serumkonzentrationen sensitiver und spezifischer Herzparameter wie das aminoterminale pro-brain natriuretic peptide (NT-proBNP) sowie das heart-type fatty acid-binding protein (H- FABP) neben Routineparametern für Myokardschädigung bestimmt. Es konnte gezeigt werden, dass es bei komplizierter Malaria, nicht aber bei unkomplizierter Malaria häufig zu einer Herzmuskelschädigung kommt, die sich durch erhöhte Serumkonzentrationen sensitiver Marker ausdrückt. Summary Cardiac impairment is thought to be rare in Plasmodium falciparum malaria. A case-control study in European travelers with uncomplicated and complicated falciparum malaria was conducted. Sensitive and specific markers for myocardial impairment like serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), heart-type fatty acid-binding protein (H-FABP), myoglobin, troponin T and CK-MB were compared. Elevated levels of NT-proBNP and H-FABP indicated substantial myocardial damage in complicated but not in uncomplicated falciparum malaria. 102 Project Description and Results Myocardial impairment in Plasmodium falciparum malaria is thought to be rare. Pulmonary edema is thought to be noncardiogenic in nature. In a case control study on severe malaria in children in northern Ghana it was felt that myocardial impairment might occur more often than expected. We conducted an unmatched case-control study in 63 patients with uncomplicated (n=52) and complicated (n=11) falciparum malaria. We measured the serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) as a sensitive marker of impaired left ventricular (LV) function, and heart-type fatty acid-binding protein (H-FABP) as a sensitive and specific marker of acute myocardial injury. Additionally we assessed myoglobin, creatine kinase muscle-brain (CK-MB), and troponin T (TnT) as established markers of myocardial injury. Cardiac impairment, as defined by elevated levels of cardiac specific markers, was found to be common in complicated but not in uncomplicated falciparum malaria. Our first results are to be verified in differernt ways. The pathogenesis of cardiac impairment is to be examined. Possible contributing factors include ischemia, acidosis, direct toxic effects of substances like glycosylphosphatidyl-inositol (GPI), or apoptosis. The latter is currently assessed in a murine model. Our results are also verified in a endemic population. Therefore, 200 serum samples of Ghanaian children with uncomplicated and 200 serum samples of children
with complicated falciparum malaria are currently analyzed. Furthermore, the clinical relevance of the obtained results will be assessed using techniques like echocardiography, magnetic resonance imaging and more invasive procedures like the transpulmonary double indicator dilution. We expect relevant insights into pathophysiology of the disease which might have impact on fluid management as well as on transfusion criteria. Selected Publications • Günther A, Grobusch MP, Slevogt H, Abel W, Burchard GD. Myocardial damage in falciparum malaria detectable by cardiac troponin T is rare. Trop Med Int Health 2003; 8: 30-32. • Ehrhardt S, Mockenhaupt FP, Agana-Nsiire P, Mathieu A, Anemana SD, Stark K, Otchwemah RN, Bienzle U. Efficacy of chloroquine in the treatment of uncomplicated, Plasmodium falciparum malaria in northern Ghana. Ann Trop Med Parasitol. 2002; 96:239-47. • Ehrhardt S, Mockenhaupt FP, Eggelte TA, Agana-Nsiire A, Stollberg C, Anemana SD, Otchwemah R, Bienzle U. Chloroquine blood concentrations and molecular markers of chloroquine-resistant Plasmodium falciparum in febrile children in northern Ghana. Trans R Soc Trop Med Hyg. 2003; 97, in press Cooperating Partners • PD Dr. Norbert W. Brattig, Department of Tropical Medicine, BNI • Dr. Christoph J. Hemmer, Department of Tropical Medicine and Infectious Diseases, University of Rostock Medical School, Rostock, Germany Investigators • Stephan Ehrhardt • Dominic Wichmann • Gerd D. Burchard 103 Clinical Department
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BERNHARD NOCHT INSTITUTE FOR TROPIC
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Human genetic variants influencing
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Research Funding / Haushaltsmittel
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Introduction The appearance of SARS
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tive project with the Faculty of Me
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since this group headed by Dr. Chri
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Vorwort Das Erscheinen der schweren
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AIDS-Forschung hat eine lange zurü
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europäisches Konsortium mit 8 Part
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Parasitology Section Selected Scien
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Zusammenfassung des Sprechers Die S
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Research Group Clos (Leishmaniasis
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Figure 2: Incidence of ALA in Hué
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jects were assigned to receive dilo
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is increased in the first 24 h of h
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the populations from the endemic ar
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CQR Dd2. In order to determine whet
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Project Description and Results A g
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Project Description and Results Ado
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39 Parasitology Section Figure 2: S
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The paraflagellar rod, a crosshatch
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Figure 1: Suggested in vivo develop
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Medical Microbiology Section Chairm
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Medical Microbiology Section Zusamm
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Publications Book chapters and Mono
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Publications Herbst R, Ott C, Jacob
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Publications Supali T, Wibowo H, Ru
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Publications Scholze H and Tannich
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Publications Graefe SE, Meyer BS, M
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Publications Schulz A, Mellenthin K
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Appendix 01. Januar 2002 Das BNI wi
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Appendix 01. Oktober 2002 Gemeinsam
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Appendix 01. April 2003 Ergebnis de
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Appendix 01. Juni 2003 Fernsehrepor
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Appendix November 2003 Inauguration
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Appendix red by solar energy could
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Appendix Ansprache von Dr. Thomas F
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Diary 2004/2005 12.-14. November 20
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Research Group Heussler (Malaria I) - Bernhard-Nocht-Institut für ...

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