Lung injury in vivax malaria: pathophysiological evidence for pulmonary vascular sequestration and posttreatment alveolar-capillary inflammation.
BACKGROUND
The mechanisms underlying lung injury in vivax malaria are not well understood. Inflammatory responses to Plasmodium falciparum and P. vivax, to our knowledge, have not previously been compared at an organ level.


METHODS
Respiratory symptoms and physiological aspects were measured longitudinally in Indonesian adults with uncomplicated vivax (n=50) and falciparum (n=50) malaria. Normal values were derived from 109 control subjects. Gas transfer was partitioned into its alveolar-capillary membrane (D(M)) and pulmonary capillary vascular (V(C)) components, to characterize the site and timing of impaired gas transfer.


RESULTS
Mean baseline V(C) volume was significantly reduced in vivax and falciparum malaria, improving with treatment in each species. Baseline D(M) function was not impaired in either species. The progressive deterioration in D(M) function after treatment was statistically significant in vivax malaria but not in uncomplicated falciparum malaria. Oxygen saturation deteriorated after treatment in vivax but improved in falciparum malaria.


CONCLUSIONS
The baseline reduction in V(C) volume but not in D(M) function suggests encroachment on V(C) volume by parasitized erythrocytes and suggests that P. vivax-infected erythrocytes may sequester within the pulmonary microvasculature. Progressive alveolar-capillary dysfunction after treatment of vivax malaria is consistent with a greater inflammatory response to a given parasite burden in P. vivax relative to that in P. falciparum.
Anstey
Nicholas M
NM
International Health Program, Infectious Diseases Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT 0811, Australia. anstey@menzies.edu.au
Handojo
Tjandra
T
Pain
Michael C F
MC
Kenangalem
Enny
E
Tjitra
Emiliana
E
Price
Ric N
RN
Maguire
Graeme P
GP
D000293:Adolescent; D000328:Adult; D000818:Animals; D001784:Blood Gas Analysis; D002196:Capillaries / Q000469:parasitology*; D004912:Erythrocytes / Q000469:parasitology; D005260:Female; D006801:Humans; D007214:Indonesia; D008137:Longitudinal Studies; D008168:Lung / Q000098:blood supply / Q000469:parasitology / Q000473:pathology / Q000503:physiopathology*; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000469:parasitology / Q000473:pathology / Q000503:physiopathology*; D016780:Malaria, Vivax / Q000188:drug therapy / Q000469:parasitology / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis; D018512:Parasitemia; D010966:Plasmodium vivax / Q000502:physiology; D011650:Pulmonary Alveoli / Q000473:pathology; D011659:Pulmonary Gas Exchange; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics
D010100:Oxygen