24 year pregnant lady presented with high grade fever with altered sensorium, diagnosed to be a case of complicated falcipaum malaria, but with very high level of uric acid (17.4 mg/dl), she responded to Inj Artisunate plus Clindamycin and her uric acid level also gradually becoming normal without any hypouricemic drugs. A second patient with long standing history of gouty arthritis with multiple tophi presented with acute severe pain and high grade fever, malarial test was positive and he responded to antimalarial and there also respond to his arthritis (he was also on colchicine)....now, my question is whether antimalarial has any effect on hyperuricemia?
Thank you Sir @FMG, my first patient had asymtomatic hyperuricemia which improved with antimalarial treatment; in second patient who was a case of chronic gout, symptoms exacerbated with malaria infection which was later subsided with antimalarial medication......in the reference, they have mentioned about central role of uric acid in malaria, even they recommend to treat with Allopurinol but they have not mention about role of antimalarial in reduction of uric acid level.
Common sense first! . With severe malaria there is an increased rate of cell death and thus presumably uric acid increase in circulation. There may also be a transient decrease in renal function and excretion. This will all normalize with recovery and has no direct relation to antimalarials.
Plasmodium species are intracellular species. They accumulate uric acid crystals in rbc. Upon lysis the uric acids are released to the blood which causes inflammatory reaction by cytokines. So plasmodium causes hyperuricemia. Kindly refer to studies about this.
I think if there is relation it would be through renal impairment and dehydration too
In falciparum malaria RBC destruction is highest as this species produces maximum number of merozoites during liver phase which are released in the blood stream and infect RBCs which results in heavy parasitaemia. After completion of erythrocytic schizogony hamozoin pigment which has haemolytic proprty, destroy the infected as well normal RBCs. Moreover this species has no preference of type of cells (younger or older ). These are the probable reasons for maximum destruction of RBCs which releases uric acid in blood circulation. Since renal inflammation also takes place in falciparum malaria, uric acid is retained in the blood circulation and not filtered. These may be the probable reasons of hyperuricemia
Thank you all for an wonderful discussion.....in one patient we use Artisunate plus Clindamycin (patient was pregnant), the next patient was on Artisunate plus Doxycyclin. We have not used Allopurinol or Febuxostat for hyperuricemia....We have started screening of uric acid for every patient with malarial fever and was trying to correlate with severity of malaria, especially with organ dysfunction.
Next interesting findings we found is relation with lipid profile, there are significant drop of HDL and increase TG in falciparum malaria.
The drug used is the treatment for malaria itself which varies according to the policy in each setting
Severe malaria inolve all organs through the circulation of many substances such as hemozoin , and many released inflammatory cytokines and so one. The lysis of RBcs could explain the accumulation of uric acids in conjunction with renal function impairment linked to plasmodium falciparum and malariae. The topic needs to be adressed in many patients in endemic zones for evaluating the extent of the phenomenon
Dear ,referring to added link.Thanks
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551755/
You can an article related to your question in Plos one 2013.
This question has now been sufficiently explored and needs to be retired.
Thank you Dr Chakrabarty, can you please give me the details of the article of PLOS one?
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