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The pathogenesis of coma in severe Plasmodium falciparum malaria remains poorly understood. Obstruction of the brain microvasculature because of sequestration of parasitized red blood cells (pRBCs) represents one mechanism that could contribute to coma in cerebral malaria. Quantitative postmortem microscopy of brain sections from Vietnamese adults dying of malaria confirmed that sequestration in the cerebral microvasculature was significantly higher in patients with cerebral malaria (CM; n = 21) than in patients with non-CM (n = 23). Sequestration of pRBCs and CM was also significantly associated with increased microvascular congestion by infected and uninfected erythrocytes. Clinicopathological correlation showed that sequestration and congestion were significantly associated with deeper levels of premortem coma and shorter time to death. Microvascular congestion and sequestration were highly correlated as microscopic findings but were independent predictors of a clinical diagnosis of CM. Increased microvascular congestion accompanies coma in CM, associated with parasite sequestration in the cerebral microvasculature.

Original publication

DOI

10.1093/infdis/jir812

Type

Journal article

Journal

J Infect Dis

Publication Date

15/02/2012

Volume

205

Pages

663 - 671

Keywords

Adult, Aged, Aged, 80 and over, Autopsy, Brain, Coma, Erythrocytes, Female, Histocytochemistry, Humans, Hyperemia, Malaria, Cerebral, Malaria, Falciparum, Male, Microscopy, Microvessels, Middle Aged, Plasmodium falciparum, Severity of Illness Index, Survival Analysis, Vietnam