Histopathology of Fatal Respiratory Distress Caused by Plasmodium vivax Malaria

Abstract

Abstract. An otherwise healthy 20-year-old woman in Goa, India, received antibiotics after a diagnosis of upper respiratory tract infection. One week later, vivax malaria was diagnosed at a health center, but the patient developed respiratory distress and lost consciousness. She arrived at emergency department in shock, breathless, and comatose. She died within minutes. Two independent laboratories later confirmed Plasmodium vivax by microscopy (140,000/μL) and by nested and real-time polymerase chain reaction methods. Post-mortem examination showed congestion of alveolar capillaries by heavy monocytic infiltrates, along with diffuse damage to alveolar membranes consistent with acute respiratory distress syndrome. Parasites seen in lung tissue were roughly proportionate to both peripheral hyperparasitemia and those seen in other organs without lesions. In this patient, vivax malaria caused a rapidly fatal respiratory distress.

On cytoadhesion of Plasmodium vivax: raison d'être?

“…More recently, one autopsy from India, which had confirmed P. vivax monoinfection by PCR, found congestion of alveolar capillaries by monocytic infiltrates and diffuse damage to alveolar membranes consistent with acute respiratory distress syndrome. Parasites were observed in lung tissue as well as in other organs without lesions (Valecha et al 2009). Despite the fact that this is evidence from a single case, this resembles the findings of cytoadhesion in P. falciparum pulmonary disease (Corbett et al 1989).…”

The immunological balance between host and parasite in malaria

“…Regardless of differences in the cell type causing the obstruction, obstruction with associated hypoxia is present, as witnessed by the heterogeneous pattern of neuronal and perivascular hypoxia that is found scattered throughout the brain and that is significantly higher in brains of mice with CM compared to non-CM brains (Hempel et al 2011). Both iRBCs and inflammatory cells are present in the pulmonary microvasculature of mice and patients with MA-ARDS or CM (Franke-Fayard et al 2005;Mohan, Sharma and Bollineni 2008;Valecha et al 2009;Fonager et al 2012;Lacerda et al 2012;Milner et al 2013). Also in placentas of mice and P. falciparum-infected patients, high numbers of iRBCs and leukocytes accumulate in the intervillous maternal space and adhere to CSA at the syncytiotrophoblast surface rather than directly to the microvascular endothelial lining (Fried and Duffy 1996;Andrews and Lanzer 2002;Neres et al 2008;Mens, Bojtor and Schallig 2010).…”

“…Phagocytes clean up the iRBC content released during schizont rupture and thus prevent these components to cause damage to the vessel wall. Intravascular marginating and/or infiltrating phagocytes with or without ingested Hz are observed in brains, lungs and placenta of both mice (Curfs et al 1993;Senaldi et al 1994;Chen, Zhang and Sendo 2000;Pais and Chatterjee 2005;Coban et al 2007;Neres et al 2008;Van den Steen et al 2008Claser et al 2011;Hee et al 2011) and patients (Duarte et al 1985;Patnaik et al 1994;Ismail et al 2000;Ordi et al 2001, Clark et al 2003Medana and Turner 2006;Serghides et al 2006;Valecha et al 2009;Dorovini-Zis et al 2011, Lacerda et al 2012Souza et al 2013;Hochman et al 2015) with CM, malaria-associated acute lung injury (MA-ALI)/ARDS or PAM, respectively. Furthermore, tissue macrophages e.g.…”

Severe and Complicated Malaria due to Plasmodium vivax

“…In some settings, P. vivax may present with concomitant bacterial infection including non-typhoidal salmonellosis or even with enteric fever [26][27][28][29]. Finally, patients may also develop seizure disorder or focal neurologic deficits during the clinical course of P. vivax mono-infection or when coinfected with P. falciparum [30][31][32]. Early recognition and institution of appropriate interventions are crucial to improve overall clinical outcomes.…”

“…Coinfection with P. falciparum should be entertained in settings where there are co-circulations of both Plasmodium species [30]. Early institution of anti-parasitic therapy is instrumental.…”