Greiner Jesse, Dorovini-Zis Katerina, Taylor Terrie E, Molyneux Malcolm E, Beare Nicholas A V, Kamiza Steve, White Valerie A
Department of Pathology and Laboratory Medicine, Vancouver General Hospital and University of British Columbia Vancouver, BC, Canada.
College of Medicine, University of Malawi Blantyre, Malawi ; Blantyre Malaria Project Blantyre, Malawi ; Department of Osteopathic Medical Specialities, Michigan State University East Lansing, MI, USA.
Front Cell Infect Microbiol. 2015 Mar 16;5:18. doi: 10.3389/fcimb.2015.00018. eCollection 2015.
The retinal and brain histopathological findings in children who died from cerebral malaria (CM) have been recently described. Similar changes occur in both structures, but the findings have not been directly compared in the same patients. In this study, we compared clinical retinal findings and retinal and cerebral histopathological changes in a series of patients in Blantyre, Malawi, who died of CM.
The features systematically compared in the same patient were: (1) clinical, gross and microscopic retinal hemorrhages with microscopic cerebral hemorrhages, (2) retinal and cerebral hemorrhage-associated and -unassociated axonal damage, and fibrinogen leakage, and (3) differences in the above features between the pathological categories of CM without microvascular pathology (CM1) and CM with microvascular pathology (CM2) in retina and brain.
Forty-seven patients were included: seven CM1, 28 CM2, and 12 controls. In the 35 malaria cases retinal and cerebral pathology correlated in all features except for non-hemorrhage associated fibrinogen leakage. Regarding CM1 and CM2 cases, the only differences were in the proportion of patients with hemorrhage-associated cerebral pathology, and this was expected, based on the definitions of CM1 and CM2. The retina did not show this difference. Non-hemorrhage associated pathology was similar for the two groups.
As postulated, histopathological features of hemorrhages, axonal damage and non-hemorrhage associated fibrinogen leakage correlated in the retina and brain of individual patients, although the difference in hemorrhages between the CM1 and CM2 groups was not consistently observed in the retina. These results help to underpin the utility of ophthalmoscopic examination and fundus findings to help in diagnosis and assessment of cerebral malaria patients, but may not help in distinguishing between CM1 and CM2 patients during life.
最近已描述了死于脑型疟疾（CM）儿童的视网膜和脑组织病理学发现。两种结构中会出现类似变化，但尚未在同一患者中对这些发现进行直接比较。在本研究中，我们比较了马拉维布兰太尔一系列死于CM患者的临床视网膜发现以及视网膜和脑组织病理学变化。
在同一患者中系统比较的特征包括：（1）临床、大体和显微镜下的视网膜出血与显微镜下的脑内出血，（2）视网膜和脑内出血相关和不相关的轴突损伤以及纤维蛋白原渗漏，（3）视网膜和脑内无微血管病变的CM（CM1）和有微血管病变的CM（CM2）病理类别之间上述特征的差异。
纳入47例患者：7例CM1、28例CM2和12例对照。在35例疟疾病例中，除了非出血相关的纤维蛋白原渗漏外，视网膜和脑病理学在所有特征上均相关。关于CM1和CM2病例，唯一的差异在于出血相关脑病理学患者的比例，基于CM1和CM2的定义，这是预期的。视网膜未显示出这种差异。两组的非出血相关病理学相似。
正如所假设的，个体患者视网膜和脑中出血、轴突损伤以及非出血相关纤维蛋白原渗漏的组织病理学特征相关，尽管在视网膜中未始终观察到CM1和CM2组之间出血的差异。这些结果有助于支持检眼镜检查和眼底发现对脑型疟疾患者诊断和评估的实用性，但可能无助于在生前区分CM1和CM2患者。
