Is human malarial coma caused, or merely deepened, by sequestration?
Much research into falciparum malaria coma assumes the primary event to be vascular obstruction by parasitized red blood cells. Recent evidence that vivax malaria, caused by a parasite traditionally thought not to block blood flow, seems to alter brain function to the same degree as falciparum malaria has seriously questioned this. These data are a timely call to reassess whether vascular obstruction should still be considered the primary cause of the coma of falciparum disease. They add to a growing literature that suggests that enhancement of brain-origin cytokines, such as tumour necrosis factor, by non-brain systemic inflammation and an appreciation of the degree to which neuronal homeostasis depends on them provide a more fruitful research direction.
Clark
Ian A
IA
School of Biochemistry and Molecular Biology, Australian National University, Canberra, ACT 0200, Australia. ian.clark@anu.edu.au
Alleva
Lisa M
LM
D001921:Brain / Q000098:blood supply; D002448:Cell Adhesion; D003128:Coma / Q000150:complications / Q000453:epidemiology / Q000469:parasitology*; D016207:Cytokines / Q000378:metabolism; D006801:Humans; D007194:India / Q000453:epidemiology; D016779:Malaria, Cerebral / Q000150:complications*; D016780:Malaria, Vivax / Q000150:complications* / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D009512:New Guinea / Q000453:epidemiology
D016207:Cytokines