2013
DOI: 10.1186/1475-2875-12-191
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A histological method for quantifying Plasmodium falciparum in the brain in fatal paediatric cerebral malaria

Abstract: BackgroundThe sequestration of Plasmodium falciparum-infected erythrocytes in brain microvasculature through cytoadherence to endothelium, is the hallmark of the definitive diagnosis of cerebral malaria and plays a critical role in malaria pathogenesis. The complex pathophysiology, which leads each patient to the final outcome of cerebral malaria, is multifaceted and thus, metrics to delineate specific patterns within cerebral malaria are needed to further parse patients.MethodsA method was developed for quant… Show more

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Cited by 22 publications
(31 citation statements)
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“…Reports associating loss of smell, deafness, and blindness with both HCM and ECM support the notion that sequestration of iRBC as well as leukocytes can cause intracranial hypertension [192] , [195] [200] . Further, leukocyte sequestration is likely also involved in intracranial hypertension during P. falciparum HCM, as artesunate treatment was more efficacious in Asian adults compared to African children with more mononuclear cell accumulation [157] , [201] , [202] and also failed to rescue HCM patients with a low parasite biomass in the brain [203] . Thus, HCM and ECM induce very similar neurological symptoms and sequelae.…”
Section: Discussionmentioning
confidence: 99%
“…Reports associating loss of smell, deafness, and blindness with both HCM and ECM support the notion that sequestration of iRBC as well as leukocytes can cause intracranial hypertension [192] , [195] [200] . Further, leukocyte sequestration is likely also involved in intracranial hypertension during P. falciparum HCM, as artesunate treatment was more efficacious in Asian adults compared to African children with more mononuclear cell accumulation [157] , [201] , [202] and also failed to rescue HCM patients with a low parasite biomass in the brain [203] . Thus, HCM and ECM induce very similar neurological symptoms and sequelae.…”
Section: Discussionmentioning
confidence: 99%
“…Subjects for our study of MR were patients from the archive of this autopsy study who had had a full clinical eye examination during life. Based on our previously published findings of the prognostic significance of severity of MR [ 7 ], cases were available from 3 groups: no MR, mild MR, and moderate/severe MR. pRBC counts in the brain, determined by histological analysis, were available for the same patients, for whom parasite sequestration in cerebral capillaries was quantified [ 16 ] (a detailed description of CM classification and cerebral pathology is available in Supplementary Table 1 ). Clinical eye examinations were performed by indirect ophthalmoscopy before death.…”
Section: Methodsmentioning
confidence: 99%
“…Three different malaria parasite elements were scored after death in the microvasculature: unpigmented pRBCs (without hemozoin; known as immature forms), pigmented pRBCs (with intraerythrocytic hemozoin; known as mature forms), and extraerythrocytic hemozoin. These evaluations were made per vessel cross-section, across a minimum of 5 tissue sections stepped through a depth of at least 200 µm of tissue thickness for each case, in a standardized fashion as described elsewhere ( Supplementary Materials ) [ 2 , 16 , 22 ]. Parasite counts were reported for at least 100 vessels for each vessel subtype examined in each specimen for each ocular tissue.…”
Section: Methodsmentioning
confidence: 99%
“…Nevertheless, the BBB composition of postcapillary venules allows leukocyte diapedesis during non-malarial brain injury [65,66]. However, leukocytes are not observed within brain tissue during CM2 [62,67], suggesting an indirect contribution of these cells to the development of cerebral malaria. Cytokine production by leukocytes during P. falciparum infection may contribute to brain endothelial cell activation, indicating that leukocyte involvement in cerebral malaria does not depend on cell-cell contact [68,69].…”
Section: Inflammatory Components In the Development Of Cerebral Malariamentioning
confidence: 99%