Coma in fatal adult human malaria is not caused by cerebral oedema
Abstract Background The role of brain oedema in the pathophysiology of cerebral malaria is controversial. Coma associated with severe Plasmodium falciparum malaria is multifactorial, but associated with histological evidence of parasitized erythrocyte sequestration and resultant microvascular conges...
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ftdoajarticles:oai:doaj.org/article:68dd93e30f4d4117a448f568964b7228 2023-05-15T15:12:00+02:00 Coma in fatal adult human malaria is not caused by cerebral oedema Pongponratn Emsri Dondorp Arjen M Mai Nguyen TH Sachanonta Navakanit Day Nicholas PJ Medana Isabelle M Hien Tran T White Nicholas J Turner Gareth DH 2011-09-01T00:00:00Z https://doi.org/10.1186/1475-2875-10-267 https://doaj.org/article/68dd93e30f4d4117a448f568964b7228 EN eng BMC http://www.malariajournal.com/content/10/1/267 https://doaj.org/toc/1475-2875 doi:10.1186/1475-2875-10-267 1475-2875 https://doaj.org/article/68dd93e30f4d4117a448f568964b7228 Malaria Journal, Vol 10, Iss 1, p 267 (2011) Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 article 2011 ftdoajarticles https://doi.org/10.1186/1475-2875-10-267 2022-12-31T07:10:21Z Abstract Background The role of brain oedema in the pathophysiology of cerebral malaria is controversial. Coma associated with severe Plasmodium falciparum malaria is multifactorial, but associated with histological evidence of parasitized erythrocyte sequestration and resultant microvascular congestion in cerebral vessels. To determine whether these changes cause breakdown of the blood-brain barrier and resultant perivascular or parenchymal cerebral oedema, histology, immunohistochemistry and image analysis were used to define the prevalence of histological patterns of oedema and the expression of specific molecular pathways involved in water balance in the brain in adults with fatal falciparum malaria. Methods The brains of 20 adult Vietnamese patients who died of severe malaria were examined for evidence of disrupted vascular integrity. Immunohistochemistry and image analysis was performed on brainstem sections for activation of the vascular endothelial growth factor (VEGF) receptor 2 and expression of the aquaporin 4 (AQP4) water channel protein. Fibrinogen immunostaining was assessed as evidence of blood-brain barrier leakage and perivascular oedema formation. Correlations were performed with clinical, biochemical and neuropathological parameters of severe malaria infection. Results The presence of oedema, plasma protein leakage and evidence of VEGF signalling were heterogeneous in fatal falciparum malaria and did not correlate with pre-mortem coma. Differences in vascular integrity were observed between brain regions with the greatest prevalence of disruption in the brainstem, compared to the cortex or midbrain. There was a statistically non-significant trend towards higher AQP4 staining in the brainstem of cases that presented with coma ( P = .02). Conclusions Histological evidence of cerebral oedema or immunohistochemical evidence of localised loss of vascular integrity did not correlate with the occurrence of pre-mortem coma in adults with fatal falciparum malaria. Enhanced expression of AQP4 water ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Malaria Journal 10 1 267 |
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Directory of Open Access Journals: DOAJ Articles |
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Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
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Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 Pongponratn Emsri Dondorp Arjen M Mai Nguyen TH Sachanonta Navakanit Day Nicholas PJ Medana Isabelle M Hien Tran T White Nicholas J Turner Gareth DH Coma in fatal adult human malaria is not caused by cerebral oedema |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
description |
Abstract Background The role of brain oedema in the pathophysiology of cerebral malaria is controversial. Coma associated with severe Plasmodium falciparum malaria is multifactorial, but associated with histological evidence of parasitized erythrocyte sequestration and resultant microvascular congestion in cerebral vessels. To determine whether these changes cause breakdown of the blood-brain barrier and resultant perivascular or parenchymal cerebral oedema, histology, immunohistochemistry and image analysis were used to define the prevalence of histological patterns of oedema and the expression of specific molecular pathways involved in water balance in the brain in adults with fatal falciparum malaria. Methods The brains of 20 adult Vietnamese patients who died of severe malaria were examined for evidence of disrupted vascular integrity. Immunohistochemistry and image analysis was performed on brainstem sections for activation of the vascular endothelial growth factor (VEGF) receptor 2 and expression of the aquaporin 4 (AQP4) water channel protein. Fibrinogen immunostaining was assessed as evidence of blood-brain barrier leakage and perivascular oedema formation. Correlations were performed with clinical, biochemical and neuropathological parameters of severe malaria infection. Results The presence of oedema, plasma protein leakage and evidence of VEGF signalling were heterogeneous in fatal falciparum malaria and did not correlate with pre-mortem coma. Differences in vascular integrity were observed between brain regions with the greatest prevalence of disruption in the brainstem, compared to the cortex or midbrain. There was a statistically non-significant trend towards higher AQP4 staining in the brainstem of cases that presented with coma ( P = .02). Conclusions Histological evidence of cerebral oedema or immunohistochemical evidence of localised loss of vascular integrity did not correlate with the occurrence of pre-mortem coma in adults with fatal falciparum malaria. Enhanced expression of AQP4 water ... |
format |
Article in Journal/Newspaper |
author |
Pongponratn Emsri Dondorp Arjen M Mai Nguyen TH Sachanonta Navakanit Day Nicholas PJ Medana Isabelle M Hien Tran T White Nicholas J Turner Gareth DH |
author_facet |
Pongponratn Emsri Dondorp Arjen M Mai Nguyen TH Sachanonta Navakanit Day Nicholas PJ Medana Isabelle M Hien Tran T White Nicholas J Turner Gareth DH |
author_sort |
Pongponratn Emsri |
title |
Coma in fatal adult human malaria is not caused by cerebral oedema |
title_short |
Coma in fatal adult human malaria is not caused by cerebral oedema |
title_full |
Coma in fatal adult human malaria is not caused by cerebral oedema |
title_fullStr |
Coma in fatal adult human malaria is not caused by cerebral oedema |
title_full_unstemmed |
Coma in fatal adult human malaria is not caused by cerebral oedema |
title_sort |
coma in fatal adult human malaria is not caused by cerebral oedema |
publisher |
BMC |
publishDate |
2011 |
url |
https://doi.org/10.1186/1475-2875-10-267 https://doaj.org/article/68dd93e30f4d4117a448f568964b7228 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Malaria Journal, Vol 10, Iss 1, p 267 (2011) |
op_relation |
http://www.malariajournal.com/content/10/1/267 https://doaj.org/toc/1475-2875 doi:10.1186/1475-2875-10-267 1475-2875 https://doaj.org/article/68dd93e30f4d4117a448f568964b7228 |
op_doi |
https://doi.org/10.1186/1475-2875-10-267 |
container_title |
Malaria Journal |
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10 |
container_issue |
1 |
container_start_page |
267 |
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1766342760901640192 |