Pulmonary pathology in pediatric cerebral malaria.
Respiratory signs are common in African children where malaria is highly endemic, and thus, parsing the role of pulmonary pathology in illness is challenging. We examined the lungs of 100 children from an autopsy series in Blantyre, Malawi, many of whom death was attributed to Plasmodium falciparum malaria. Our aim was to describe the pathologic manifestations of fatal malaria; to understand the role of parasites, pigment, and macrophages; and to catalog comorbidities. From available patients, which included 55 patients with cerebral malaria and 45 controls, we obtained 4 cores of lung tissue for immunohistochemistry and morphological evaluation. We found that, in patients with cerebral malaria, large numbers of malaria parasites were present in pulmonary alveolar capillaries, together with extensive deposits of malaria pigment (hemozoin). The number of pulmonary macrophages in this vascular bed did not differ between patients with cerebral malaria, noncerebral malaria, and nonmalarial diagnoses. Comorbidities found in some cerebral malaria patients included pneumonia, pulmonary edema, hemorrhage, and systemic activation of coagulation. We conclude that the respiratory distress seen in patients with cerebral malaria does not appear to be anatomic in origin but that increasing malaria pigment is strongly associated with cerebral malaria at autopsy.
Anatomic & Clinical Pathology, The Brigham & Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA; The Blantyre Malaria Project, University of Malawi College of Medicine, 32256, Chichiri, Blantyre 3, Malawi. Electronic address: dmilner@partners.org.
Danny
D
Milner
Rachel
R
Factor
Rich
R
Whitten
Richard A
RA
Carr
Steve
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Kamiza
Geraldine
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Pinkus
Malcolm
M
Molyneux
Terrie
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Taylor
D000293:Adolescent; D015703:Antigens, CD / Q000378:metabolism; D001921:Brain / Q000378:metabolism / Q000469:parasitology / Q000473:pathology*; D002196:Capillaries / Q000378:metabolism / Q000469:parasitology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008168:Lung / Q000378:metabolism / Q000469:parasitology / Q000473:pathology*; D008264:Macrophages / Q000378:metabolism / Q000469:parasitology / Q000473:pathology*; D016779:Malaria, Cerebral / Q000378:metabolism / Q000469:parasitology / Q000473:pathology*; D008297:Male; D011014:Pneumonia / Q000378:metabolism / Q000469:parasitology / Q000473:pathology; D046888:Tissue Array Analysis
D015703:Antigens, CD
Africa; Cerebral malaria; Immunohistochemistry; Lung; Macrophages; Malaria; Pediatric; Tissue arrays