title: Liver changes in severe Plasmodium falciparum malaria: histopathology, apoptosis and nuclear factor kappa B expression.
abstract: BACKGROUND
  Liver involvement in severe Plasmodium falciparum infection is commonly a significant cause of morbidity and mortality among humans. The clinical presentation of jaundice often reflects a certain degree of liver damage. This study investigated the liver pathology of severe P. falciparum malaria as well as the regulation and occurrence of apoptosis in cellular components of formalin-fixed, paraffin-embedded liver tissues.
  
  
  METHODS
  The liver tissues used in the study came from patients who died from P. falciparum malaria with hyperbilirubinaemia (total bilirubin (TB)≥ 51.3 μmol/L or 3 mg/dl) (12 cases), P. falciparum malaria without hyperbilirubinaemia (TB<51.3 μmol/L) (10 cases); and patients who died due to accidents, whose liver histology was normal (the control group) (10 cases). The histopathology of the liver tissue was studied by routine histology method. Caspase-3 and nuclear factor kappa B (NF-κB) p65 expressions were determined using immunohistochemistry.
  
  
  RESULTS
  The severity of liver histopathology, occurrence of apoptosis and NF-κB p65 activation in P. falciparum malaria were associated with higher TB level. Significant correlations were found between NF-κB p65 expression and apoptosis in Kupffer cells and lymphocytes in the portal tracts.
  
  
  CONCLUSIONS
  Hyperplastic Kupffer cells and portal tract inflammation are two main features found in the liver tissues of severe P. falciparum malaria cases. In addition, NF-κB is associated with Kupffer cells and lymphocyte apoptosis in severe P. falciparum malaria.
authors.affiliation: Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand. parnpen.vir@mahidol.ac.th.
authors.forename: Parnpen
authors.initials: P
authors.lastname: Viriyavejakul
authors.forename: Vasant
authors.initials: V
authors.lastname: Khachonsaksumet
authors.forename: Chuchard
authors.initials: C
authors.lastname: Punsawad
mesh_terms: D017209:Apoptosis; D053148:Caspase 3 / Q000032:analysis; D006505:Hepatitis / Q000473:pathology*; D006651:Histocytochemistry; D006801:Humans; D007150:Immunohistochemistry; D008099:Liver / Q000473:pathology; D008214:Lymphocytes / Q000276:immunology; D016778:Malaria, Falciparum / Q000150:complications / Q000473:pathology*; D051996:Transcription Factor RelA / Q000032:analysis*
chemical_list: D051996:Transcription Factor RelA; D053148:Caspase 3