Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan (USA).
Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi.
Dr. Taylor was a student in the M.Trop.Med program at the Liverpool School of Tropical Medicine in 1985. With encouragement from Professor and Dean Herbert Gilles, she and Professor Malcolm Molyneux established a Paediatric Research Ward at the Queen Elizabeth Central Hospital in Blantyre, Malawi. Their research priority was identified by the Malawi Ministry of Health, cerebral malaria in Malawian children, and their focus was on malaria pathogenesis, with the ultimate goal being to improve the outcomes (both short and long term) of Malawian children with cerebral malaria.
Over the ensuing decades, they established and validated the Blantyre Coma Score, characterized the clinical syndrome in detail (including malarial retinopathy, in conjunction with Prof. Simon Harding and Dr. Susan Lewallen), conducted an autopsy-based study of clinicopathological correlates of cerebral malaria (with Prof. Sebastian Lucas and Dr. Dan Milner), and incorporated magnetic resonance imaging (MRI), which highlighted a strong association between increased brain volume and death. The Blantyre-based team is currently in the throes of an interventional clinical trial in children with retinopathy-positive cerebral malaria and increased brain volume (per MRI).
The clinical malaria work in Blantyre started as a collaboration between Drs. Taylor and Molyneux, and remains a vibrant collaborative activity involving faculty and students from Michigan State University and the Liverpool School of Tropical Medicine.
I have been living and working in Malawi for six straight months each year (January – June, the “malaria season”) since 1986. Our focus has been on the pathogenesis of cerebral malaria. We provide clinical care for children with cerebral malaria and, in that context, study the disease. This has included conducting 4 interventional clinical trials, recognizing malarial retinopathy and establishing its importance, orchestrating the largest single autopsy study of fatal cerebral malaria, and coordinating the introduction of magnetic resonance imaging in Malawi.
The children hospitalized on the Paediatric Research Ward in Blantyre are probably the most exhaustively characterized cerebral malaria patients in the world. We routinely perform full and detailed ophthalmoscopic examinations to determine retinopathy status. Parents are pre-counseled if the HIV status of the child is unknown so that we can test the child. EEGs on admission and then as needed throughout the hospitalization are routine, as is magnetic resonance imaging. Skilled research nurses and clinicians are available around the clock to respond to changes in clinical condition. The supply chain for medications and clinical supplies is reliable, there is a back-up power supply, and we have always been able to obtain blood for transfusion when necessary. We have enjoyed NIH support throughout most of this effort.
Since 2010, I have also served as the Program Director for the Malawi ICEMR (International Centers of Excellence in Malaria Research). With ICEMR support, we have established the capacity for eco-entomological field work in Malawi, executed a series of cross-sectional surveys, carried out inpatient and outpatient facility-based surveillance, and are currently in the second year of a longitudinal cohort study (including infants).
In early 2018, we started an interventional clinical trial comparing immediate hyperventilation or hypertonic saline to usual care in Malawian children with CM and increased brain volume. This study is taking place in Malawi’s first paediatric intensive care unit. We hope that this study will support other investigations into the etiology of increased brain volume in this patient population.
In addition to teaching medical parasitology to medical students at Michigan State University, I also facilitate an overseas elective experience in Malawi. Each year, three groups of 8 MSU students spend six weeks on the wards of the Queen Elizabeth Central Hospital.