Milner Danny A, Lee Jonathan J, Frantzreb Charles, Whitten Richard O, Kamiza Steve, Carr Richard A, Pradham Alana, Factor Rachel E, Playforth Krupa, Liomba George, Dzamalala Charles, Seydel Karl B, Molyneux Malcolm E, Taylor Terrie E
Department of Pathology, Brigham and Women's Hospital Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston, Massachusetts Blantyre Malaria Project, University of Malawi College of Medicine.
Department of Pathology, Brigham and Women's Hospital.
J Infect Dis. 2015 Oct 15;212(8):1317-21. doi: 10.1093/infdis/jiv205. Epub 2015 Apr 7.
Children in sub-Saharan Africa continue to acquire and die from cerebral malaria, despite efforts to control or eliminate the causative agent, Plasmodium falciparum. We present a quantitative histopathological assessment of the sequestration of parasitized erythrocytes in multiple organs obtained during a prospective series of 103 autopsies performed between 1996 and 2010 in Blantyre, Malawi, on pediatric patients who died from cerebral malaria and controls. After the brain, sequestration of parasites was most intense in the gastrointestinal tract, both in patients with cerebral malaria and those with parasitemia in other organs. Within cases of histologically defined cerebral malaria, which includes phenotypes termed "sequestration only" (CM1) and "sequestration with extravascular pathology" (CM2), CM1 was associated with large parasite numbers in the spleen and CM2 with intense parasite sequestration in the skin. A striking histological finding overall was the marked sequestration of parasitized erythrocytes across most organs in patients with fatal cerebral malaria, supporting the hypothesis that the disease is, in part, a result of a high level of total-body parasite sequestration.
尽管人们努力控制或消灭致病原恶性疟原虫，但撒哈拉以南非洲的儿童仍不断感染脑型疟疾并因此死亡。我们对1996年至2010年间在马拉维布兰太尔对死于脑型疟疾的儿科患者及对照进行的103例前瞻性尸检中获取的多个器官内寄生红细胞的滞留情况进行了定量组织病理学评估。除脑部外，脑型疟疾患者以及其他器官有寄生虫血症的患者，胃肠道内的寄生虫滞留最为严重。在组织学定义的脑型疟疾病例中，包括“仅滞留”（CM1）和“伴有血管外病理改变的滞留”（CM2）两种表型，CM1与脾脏中大量寄生虫有关，CM2与皮肤中强烈的寄生虫滞留有关。总体而言，一个显著的组织学发现是，致命性脑型疟疾患者的大多数器官中都有明显的寄生红细胞滞留，这支持了该病部分是全身寄生虫高水平滞留所致的假说。
