Publication: An ultrastructural study of the brain in fatal Plasmodium falciparum malaria
Issued Date
2003-10-01
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ISSN
00029637
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2-s2.0-0642373872
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Mahidol University
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SCOPUS
Bibliographic Citation
American Journal of Tropical Medicine and Hygiene. Vol.69, No.4 (2003), 345-359
Suggested Citation
Emsri Pongponratn, Gareth D.H. Turner, Nicholas P.J. Day, Nguyen Hoan Phu, Julie A. Simpson, Kasia Stepniewska, Nguyen Thi Hoan Mai, Parnpen Viriyavejakul, Sornchai Looareesuwan, Tran Tinh Hien, David J.P. Ferguson, Nicholas J. White An ultrastructural study of the brain in fatal Plasmodium falciparum malaria. American Journal of Tropical Medicine and Hygiene. Vol.69, No.4 (2003), 345-359. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/20880
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Title
An ultrastructural study of the brain in fatal Plasmodium falciparum malaria
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Abstract
Cerebral malaria (CM) is a major cause of death in severe Plasmodium falciparum malaria. We present quantitative electron microscopic findings of the neuropathologic features in a prospective clinicopathologic study of 65 patients who died of severe malaria in Thailand and Vietnam. Sequestration of parasitized red blood cells (PRBCs) in cerebral microvessels was significantly higher in the brains of patients with CM compared with those with non-cerebral malaria (NCM) in all parts of the brain (cerebrum, cerebellum, and medulla oblongata). There was a hierarchy of sequestration with more in the cerebrum and cerebellum than the brain stem. When cerebral sequestration was compared with the peripheral parasitemia pre mortem, there were 26.6 times more PRBCs in the brain microvasculature than in the peripheral blood. The sequestration index was significantly higher in CM patients (median = 50.7) than in NCM patients (median = 6.9) (P = 0.042). The degree of sequestration of P. falciparum-infected erythrocytes in cerebral microvessels is quantitatively associated with pre-mortem coma.