Dr. Terrie Taylor has, with the full support of the Michigan State University College of Osteopathic Medicine, been living and working in Malawi for six months each year since 1986. There, she has coordinated a series of studies into the pathogenesis of fatal cerebral malaria in Malawian children, providing care on the Paediatric Research Ward whilst exploring a series of different hypotheses. She has been fortunate to work with a wide variety of collaborators over the years: neurologists, pathologists, radiologists, ophthalmologists and, most recently, pediatric intensivists. At the same time, she has hosted final year medical students from Michigan State, providing them with an opportunity to care for patients in a vastly different setting. Her work has been recognized by numerous awards over the years. In December of 2024, Dr. Taylor stepped away from the bedside and is now a Senior Advisor to the Dean for Research Initiatives and Global Scholarship.
Beginning in 1986, Drs. Terrie Taylor and Malcolm Molyneux, at the behest of the Malawi Ministry of Health, began studying cerebral malaria in Malawian children. In her lecture, Dr. Taylor will discuss nearly forty years of clinical research during which the team in Malawi has combined bedside observations, autopsy findings, neuroimaging, EEGs and transcranial doppler data to understand how P. falciparum kills over 500,000 African children annually. Work on the Paediatric Research Ward produced the Blantyre Coma Score, enshrined in the WHO’s clinical case definition of cerebral malaria. The clinicopathological study showed that the standard clinical case definition of cerebral malaria misclassified ~23% of patients — but when ‘malarial retinopathy’, a constellation of up to three clinical features observable on ocular funduscopy, was included, the specificity of the standard clinical case definition, which misclassifies ~25% of cases, increases to 88%. The autopsy study failed to identify the cause of death in the retinopathy-positive cases of true cerebral malaria, but when magnetic resonance imaging became available, the importance of increased brain volume became apparent. The heterogeneity in this patient population has recently been revealed by transcranial Doppler studies; there are five different clinical phenotypes, suggesting that a single “silver bullet” to treat increased brain volume is unlikely. Potential mechanisms underlying the TCD phenotypes and potential treatments will be discussed. The puzzle is nearing completion, but work remains to be done.