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Title: Sequestration and microvascular congestion are associated with coma in human cerebral malaria
Authors: Mark J. Ponsford
Isabelle M. Medana
Panote Prapansilp
Tran Tinh Hien
Sue J. Lee
Arjen M. Dondorp
Margaret M. Esiri
Nicholas P J Day
Nicholas J. White
Gareth D H Turner
Nuffield Department of Clinical Medicine
University of Oxford
Mahidol University
Keywords: Medicine
Issue Date: 15-Feb-2012
Citation: Journal of Infectious Diseases. Vol.205, No.4 (2012), 663-671
Abstract: 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. © 2011 The Author.
ISSN: 00221899
Appears in Collections:Scopus 2011-2015

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