Laboratory of Malaria, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Av. Pedro Teixeira, 25, Manaus, Amazonas 69040-000, Brazil.
Clin Infect Dis. 2012 Oct;55(8):e67-74. doi: 10.1093/cid/cis615. Epub 2012 Jul 6.
Severe disease attributable to Plasmodium vivax infection is already well described worldwide; however, autopsies in these patients are scarce.
From 1996 to 2010, 19 patient deaths with a clinical diagnosis of P. vivax infection occurred in a tertiary care center in the Brazilian Amazon. Seventeen of these 19 deaths were fully autopsied. Clinical charts, macroscopic autopsy reports, and stored paraffinized tissue blocks were retrieved. Nested polymerase chain reaction was performed in paraffinized samples of spleen and lung to confirm P. vivax monoinfection. Immunohistofluorescence was used to detect P. vivax parasitized red blood cells (RBCs).
Of 17 autopsies, 13 revealed that death could be attributed to P. vivax infection; in the remaining 4, acute diseases other than malaria were found to be the cause of death. The primary complication in patients in which malaria contributed to death was acute respiratory distress syndrome (ARDS) and pulmonary edema associated with the accumulation of neutrophils in the interalveolar space (6 cases). Spleen rupture (3 cases) and multiorgan dysfunction syndrome (3 cases) were the second most common complications. One child evolving with coma was also characterized, but no parasite was detected in the brain tissue. In one patient who developed ARDS and presented negative peripheral parasitemia by the time of death, scattered parasitized red blood cells were seen inside pulmonary capillaries, suggesting some sequestration in the lung.
In 13 of 17 deceased patients, P. vivax infection was the plausible cause of death. However, more studies are needed to understand pathogenesis related to severe disease.
已在全球范围内充分描述了归因于间日疟原虫感染的严重疾病；然而，这些患者的尸检却很少。
1996 年至 2010 年，在巴西亚马逊地区的一家三级保健中心，有 19 例临床诊断为间日疟原虫感染的患者死亡。这 19 例死亡中有 17 例进行了全面尸检。检索了临床病历、大体解剖报告和储存的石蜡组织块。在脾和肺的石蜡样本中进行巢式聚合酶链反应以确认间日疟原虫单纯感染。免疫荧光法用于检测间日疟原虫寄生的红细胞（RBC）。
在 17 例尸检中，有 13 例发现死亡可归因于间日疟原虫感染；在其余 4 例中，除疟疾以外的急性疾病被发现是死亡的原因。间日疟原虫导致死亡的患者的主要并发症是急性呼吸窘迫综合征（ARDS）和与中性粒细胞在肺泡间隙积聚相关的肺水肿（6 例）。脾破裂（3 例）和多器官功能障碍综合征（3 例）是第二常见的并发症。还出现了 1 例伴有昏迷的儿童，但脑组织中未检测到寄生虫。在 1 例发生 ARDS 且在死亡时外周血无寄生虫血症的患者中，可见散在的寄生红细胞在肺毛细血管内，提示在肺部有一些定殖。
在 17 例死亡患者中，有 13 例间日疟原虫感染可能是死亡的原因。然而，还需要更多的研究来了解与严重疾病相关的发病机制。
