#MSPInfectología l ¿Sabías que la malaria puede desencadenar alteraciones neurológicas graves en solo horas? Conéctate ahora con la Dra. Terry Ellen Taylor, Doctora en Medicina Osteopática e Investigadora, para conocer cómo se diagnostican, evolucionan y por qué es tan letal esta complicación.
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#MSP: El lugar donde médicos, pacientes y profesionales de la salud pueden entrar. #SomosCiencia
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00:50Let me switch to English.
00:52Today we are honoured to speak with two distinguished guests as a part of the annual Ashford Memorial Conference
00:59organized by the University of Puerto Rico School of Medicine, which is celebrating its 75th anniversary.
01:06First, we welcome Dr. Terry Ellen Taylor, a physician and researcher known,
01:11for her work on cerebral malaria, the most severed and life-threatening form of the disease.
01:18Thank you very much for being here with us today, Dr. Terry.
01:22Thank you very much.
01:23Okay, Dr. Taylor, you are a specialist in cerebral malaria, one of the most severed forms of the disease.
01:30For those who may not know, could you explain what cerebral malaria is and why it is so dangerous?
01:37Thank you very much.
01:39Cerebral malaria is, as you said, one of the most severe manifestations of infections with the malaria parasite.
01:48Specifically, in this case, Plasmodium falciparum.
01:51And it affects the brains of a small proportion of people who are infected.
02:00So, overall, it's in the scope of malaria infections, it's a rare event.
02:05But since there are so many malaria infections in the world, there's a lot of cerebral malaria.
02:13The typical clinical picture is coma and convulsions.
02:20And it can come on very rapidly.
02:23Most of the cerebral malaria in the world happens in sub-Saharan Africa, over 90%.
02:29And there, the burden is borne by young children because they haven't had enough experience with the parasite.
02:37They haven't developed any immunity.
02:40So, typically, parents of those young children will recognize that their child has cerebral malaria
02:47when the child begins having seizures or fits and loses consciousness.
02:52And what have been some of the most important findings in your research?
02:58Because I know that you were in Africa.
03:01And regarding the effects of malaria on the brain.
03:04I've been reflecting on this in the context of the Bailey K. Ashford Memorial Lecture.
03:10And Bailey K. Ashford came upon the anemia-afflicting workers here in Puerto Rico before anyone else had ever looked at it
03:22and was able to make seminal contributions.
03:25When we started working on cerebral malaria back in 1986, it was really, in many respects, in the infancy of studies of this condition.
03:40So, at the time, people used adjectives to refer to the children who were affected.
03:47They were stuporous or drowsy or unrousable.
03:51And one of the first things that we did was develop a scoring system, a very simple five-part scoring system
04:00that could indicate the depth of the coma.
04:05We named it the Blantyre Coma Score because we were working in Blantyre, Malawi.
04:11So, being able to judge the depth of coma in a way that could be carried across from patient to patient,
04:19hospital to hospital, country to country, turned out to be very, very useful.
04:26Another of the very first contributions we made came about because of the insight of my first colleague,
04:34Professor Malcolm Molyneux from the Liverpool School of Tropical Medicine,
04:38who wondered if perhaps low blood sugar was contributing to the comas.
04:44And sure enough, 20% of kids with cerebral malaria had low blood sugar.
04:50Some of them regained consciousness when they were given sugar, 50% dextrose.
04:57And those kids didn't have cerebral malaria.
05:00They just had low blood sugar.
05:01But a significant proportion of kids with cerebral malaria did have low blood sugar.
05:06And so, checking for that and treating for that became an early first contribution that we were able to make.
05:15Got it.
05:16And I would like to know more details about the symptoms of malaria
05:20and what signs should alert us to a more serious condition like cerebral malaria, doctor?
05:28Well, that's a good question.
05:30And it's one that unsettles a lot of parents in malaria endemic parts of sub-Saharan Africa
05:38because you can imagine their children develop many fevers over the course of a year.
05:44And they can't rush into the hospital for every single fever.
05:47That consumes too many resources, takes too much time, etc.
05:51So, unfortunately for malaria, the parents often do not know until the symptoms become very serious.
06:01So, the child may have had a fever during the day.
06:04They put the child to bed.
06:06And the next morning, they can't wake the child up.
06:08Or the child has a fever, is still playing and eating, and then has a seizure and can't be roused from the seizure.
06:16So, unfortunately, the malaria symptoms, the cerebral malaria symptoms, come on very rapidly.
06:24But there have been two really important innovations in managing this syndrome.
06:34One is the development of diagnostic tests that can look at a febrile child and see if they have malaria parasites.
06:43Those tests can now be done by a village health worker without any access even to electricity.
06:51And the second bold, the second important innovation is the development of rapidly effective oral drugs against malaria.
07:03So, when I started, it was in the chloroquine era, and chloroquine rapidly lost its efficacy.
07:10And the world got to work on developing new anti-malarials.
07:14And now we have drugs based on an old Chinese herbal remedy, Qing Haotzu.
07:21The artemisinin is the active ingredient of Qing Haotzu.
07:25Artemisinin-based drugs are so effective.
07:28So, now, in a village, a health worker can do a quick blood test on a child with a fever, and if they have malaria, administer these drugs by mouth, and the children rapidly improve.
07:46So, we're able to kind of nip the development of cerebral malaria in the bud at a very early stage and prevent patients and children in villages from progressing.
07:59Got it.
08:00And besides this, the diagnosis test, blood test, are there any promising, maybe, advance or treatments on the horizon that give hope for patients with malaria and cerebral malaria?
08:15Yes. Thanks for asking that question, because as of the last two years, we have licensed malaria vaccines, which have been made available.
08:25There are two of them.
08:26They're closely related immunologically, and they are now being rolled out across sub-Saharan Africa.
08:35They are meant to be administered to very young children to protect them during this vulnerable early stage of life.
08:43And they have been shown to reduce the number of children presenting to hospital with cerebral malaria.
08:50They, these vaccines on their own, are not the be-all and end-all of malaria control, but when combined with bed nets, indoor residual spraying, and this rapid diagnosis and treatment at village level,
09:10they have begun to really make a dent in the burden of disease experienced by young African children.
09:16And regarding your experience, what challenges do research face when studying malaria in the regions where it is most prevalent?
09:26You are a researcher.
09:27Tell me more details about it.
09:30Thank you.
09:30That's a great question.
09:32There are so many challenges that we face working in malaria endemic areas.
09:39I often think that academics who choose to do this should be given extra points for difficulty when it comes time for promotion and tenure decisions, because every bit of data requires more effort.
09:55So the challenges range from sort of the technical challenges.
10:01Can you sustain an internet connection?
10:03Will there be electricity?
10:04How much backup power do you have when there's a power cut to the ethical?
10:10How do parents feel about admitting a comatose child to a hospital and being approached at the time of admission to have their child be part of a study?
10:22Is there an ethical way to do that?
10:25Can we, can we as expatriates working in Malawi negotiate that in a way that isn't threatening or coercive?
10:34So there are so many different challenges, which I think combine to make the work extremely interesting.
10:43How do you feel about being part of this event?
10:46We also remind our audience that that conference will take place tomorrow from 11 to 1 p.m.
10:55at Amphitheater number one, located at the Medical Sciences Campus.
11:00How do you feel about being part of this event, especially one that commemorates such a key figure in medical history like Dr. Ashford?
11:11Thank you.
11:12It is really a distinct honor to be invited to deliver this lecture.
11:18I've been a member of the American Society of Tropical Medicine and Hygiene throughout my career.
11:24And the name of Bailey K. Ashford is known to all of us.
11:29A medal for young stage investigators is in his honor.
11:35He's an inspirational figure for me because he moved from basic clinical observations through to an impressive program, not only of diagnosing and treating helminthic infections here,
11:58but expanding the footprint of public health and tropical public health in a way that sustained and expanded his activities.
12:09I think we all can learn a lot from his selfless example.
12:15In your view, what is the importance of keeping malaria on the global health agenda, even in places like Puerto Rico?
12:24So, I have a great deal of respect for the malaria parasite.
12:29It is beyond clever.
12:31It's nefarious.
12:33I've once referred to it as the Voldemort of parasites because it is so tricky.
12:39It will exploit any avenue we provide it.
12:44For instance, its genome is very rich in adenosine and thymidine, right?
12:51And those are two bases which are unstable when it comes to doing polymerase chain reactions.
12:59So, it's even difficult to study it because of its genetic makeup.
13:05And it anticipated that millennia before.
13:09It has shaped the human genome.
13:12It will not go away easily.
13:15It will not go quietly into the night.
13:17We have to maintain pressure on it in multiple different directions.
13:23It will always be developed in drug resistance.
13:25We need to be working on new drugs.
13:27We have to effectively promulgate the vaccines, even insecticides.
13:33Mosquitoes develop resistance behaviorally and genetically to insecticides.
13:39So, it's not a one and done with malaria.
13:42We have to maintain the pressure.
13:45We have to maintain good public health systems of control to keep it at bay.
13:51I'm not personally invested in eradicating the parasite from the world.
13:57I do believe we have the ways and means to eradicate malaria deaths, however.
14:02And finally, I would like to ask you a recommendation for the people who are watching, maybe students of medicine who are interested in working with malaria medical disease.
14:22Oh, let me think about that.
14:25There are lots of different angles now for malaria.
14:29As I mentioned, one is drug development.
14:32That is always going to be a rich area for malaria because the parasite will be racing to get ahead of us.
14:39The clinical work now is delving more deeply into the immunological and neurological, very basic neurological responses.
14:52So, neuroscientists, there's a bevy of work to be done.
14:57For intensivists, there is a lot of very basic work that remains to be done.
15:02And for people who are working on the cellular level based on tissues from patients with malaria acutely or with fatal cases of malaria, there are a number of fascinating questions.
15:19Entomology is alive and well.
15:21We have to be, again, staying ahead of the parasite when it comes to combating mosquitoes and the interface between humans and mosquitoes.
15:30So, I would say, even though we've made giant strides against the infection and the disease in recent years, we cannot relent.
15:41We have to stay on task and stay ahead of the parasite and the Anopheles mosquito vector.
15:49Why do you think it's important to talk about malaria disease?
15:54Do you think it is an issue of public health?
15:58I do.
15:58I think a lot of managing malaria as a disease does come down to an intact public health system, primarily with respect to what we can do now in terms of early diagnosis, way out at the peripheral level with these rapid diagnostic tests and effective drugs, and prevention in terms of the malaria vaccines and minimizing exposure to the vector, the Anopheles mosquitoes.
16:27So, an intact public health system is hugely important, and the hot spots of malaria these days are parts of the world where the public health system is challenged by civil unrest, actually.
16:44Okay, Dr. Taylor, thank you so much for sharing your time, your knowledge, and insights with us today.
16:50Your work continues to inspire and educate, and we are grateful to have had the chance to learn more details about the impact of malaria and the importance of ongoing research.
17:05Thank you very much.
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