For the past three decades, osteopathic physician and infectious disease expert, Dr. Terrie Taylor, has made an annual pilgrimage from Michigan to Malawi in pursuit of an answer to a deadly puzzle. Each year, malaria claims the lives of 575,000 children worldwide – or 1,300 every day– mostly in Africa. And even though researchers have long suspected that brain swelling is the cause of death for patients with the most fatal form of the disease, cerebral malaria, they haven’t been able to firmly establish the link. Until now.
This month, a study published in the New England Journal of Medicine demonstrates how Dr. Taylor, a professor at Michigan State University, and her team were able to determine the exact cause of death for children with cerebral malaria, using an MRI provided by GE Healthcare.
While drugs already exist that effectively kill the malaria parasite, Dr. Taylor expects her study to break new ground in identifying ways to treat the effects of the disease.“Before, we were kind of taking pot shots,” she said. “But now we know… our focus is much better.”
Top image: Dr. Terrie Taylor from Michigan State University holds a child in the Queen Elizabeth Hospital in Blantyre, Malawi, Africa. Photo by Jim Peck, MSU. Above: This brain scan shows normal brain volumes in a 14-month old girl at the time of a one month follow-up image series.
Dr. Taylor’s fight against malaria, which she calls the “Voldemort of parasites,” began 28 years ago, when she first landed in Blantyre, Malawi, near the country’s mountainous Zomba Plateau. Since then, she’s spent six months of every year in Africa, studying children with cerebral malaria at the Queen Elizabeth Hospital.
Standing at their bedsides, she said, it seemed as though they were dying from brain herniation, or brain swelling so severe the pressure shifts brain tissue, sometimes causing a patient to stop breathing. But evidence for her team’s hypothesis remained elusive for decades.
Above: This brain scan shows increased brain volume in a 19-month old girl with retinopathy-positive cerebral malaria.
For 10 years, they conducted autopsy after autopsy, looking for indicators that brain herniation was the precise cause of death. But it wasn’t until they were able to look at scans from an MRI, which are too costly for most hospitals in developing countries, that they were finally able to “catch the parasite in the act,” she said.
GE provided an MRI to Queen Elizabeth hospital, which – through a stroke of pure serendipity – arrived at the hospital on World Malaria Day in May 2008.
When her team reviewed the scans of one of the very first research patients, Dr. Taylor said, they immediately knew that they were on the right track. The MRI scans of the child who had recently died from cerebral malaria indicated increased brain volume and displacement of brain tissue.“I remember exactly where I was standing,” she said. “It was one of those moments that you hardly ever get in science.”
A child is prepared for MRI at the Queen Elizabeth Hospital in Blantyre,Malawi, Africa. Photo by Terrie Taylor, MSU
The problem with the autopsies, she explained, was that the very act of conducting them obscured the key finding: researchers needed to remove the skull cap to access the brain, thereby relieving any pressure before it could be observed. “When we moved to the MRI, it was blatantly obvious,” Dr. Taylor said. “It was so obvious that those kids are herniating, per the MRI, that we couldn’t escape the fact.”
Since 2008, funded by the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, Dr. Taylor and her team have reviewed the brain images of hundreds of African children. Now, armed with evidence from the study, she said they can move forward on two parallel tracks: further research into the causes of brain swelling to identify suitable medical treatment and the exploration of a clinical trial that provides ventilator support for children until the swelling resolves on its own.
As is the nature of science, the best discoveries simply beget more questions. But Dr. Taylor said that, with this finding, they’re at least finally “at the heart of what is killing these kids.”“We never, ever would have appreciated this mechanism of death had we not had the MRI,” she said. “It was completely, absolutely critical.”