title: The systemic pathology of cerebral malaria in African children.
abstract: Pediatric cerebral malaria carries a high mortality rate in sub-Saharan Africa. We present our systematic analysis of the descriptive and quantitative histopathology of all organs sampled from a series of 103 autopsies performed between 1996 and 2010 in Blantyre, Malawi on pediatric cerebral malaria patients and control patients (without coma, or without malaria infection) who were clinically well characterized prior to death. We found brain swelling in all cerebral malaria patients and the majority of controls. The histopathology in patients with sequestration of parasites in the brain demonstrated two patterns: (a) the "classic" appearance (i.e., ring hemorrhages, dense sequestration, and extra-erythrocytic pigment) which was associated with evidence of systemic activation of coagulation and (b) the "sequestration only" appearance associated with shorter duration of illness and higher total burden of parasites in all organs including the spleen. Sequestration of parasites was most intense in the gastrointestinal tract in all parasitemic patients (those with cerebral malarial and those without).
authors.affiliation: Department of Pathology, Brigham and Women's Hospital Boston, MA, USA ; Department of Immunology and Infectious Disease, Harvard School of Public Health Boston, MA, USA ; The Blantyre Malaria Project, College of Medicine, University of Malawi Blantyre, Malawi.
authors.forename: Danny A
authors.initials: DA
authors.lastname: Milner
authors.affiliation: CellNetix Pathology and Laboratories Olympia, Washington, USA.
authors.forename: Richard O
authors.initials: RO
authors.lastname: Whitten
authors.affiliation: Department of Histopathology, College of Medicine, University of Malawi Blantyre, Malawi.
authors.forename: Steve
authors.initials: S
authors.lastname: Kamiza
authors.affiliation: Department of Histopathology, South Warwickshire General Hospitals Warwick, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Carr
authors.affiliation: Department of Histopathology, College of Medicine, University of Malawi Blantyre, Malawi.
authors.forename: George
authors.initials: G
authors.lastname: Liomba
authors.affiliation: Department of Histopathology, College of Medicine, University of Malawi Blantyre, Malawi.
authors.forename: Charles
authors.initials: C
authors.lastname: Dzamalala
authors.affiliation: The Blantyre Malaria Project, College of Medicine, University of Malawi Blantyre, Malawi ; Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University East Lansing, MI, USA.
authors.forename: Karl B
authors.initials: KB
authors.lastname: Seydel
authors.affiliation: Department of Histopathology, College of Medicine, University of Malawi Blantyre, Malawi ; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine Blantyre, Malawi ; Liverpool School of Tropical Medicine, University of Liverpool Liverpool, UK.
authors.forename: Malcolm E
authors.initials: ME
authors.lastname: Molyneux
authors.affiliation: The Blantyre Malaria Project, College of Medicine, University of Malawi Blantyre, Malawi ; Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University East Lansing, MI, USA.
authors.forename: Terrie E
authors.initials: TE
authors.lastname: Taylor
mesh_terms: D001344:Autopsy; D001921:Brain / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004702:Endocrine Glands / Q000469:parasitology / Q000473:pathology; D004912:Erythrocytes / Q000469:parasitology / Q000473:pathology; D041981:Gastrointestinal Tract / Q000469:parasitology / Q000473:pathology; D006099:Granuloma / Q000473:pathology; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D007223:Infant; D008168:Lung / Q000469:parasitology / Q000473:pathology; D016779:Malaria, Cerebral / Q000453:epidemiology / Q000469:parasitology / Q000473:pathology*; D008295:Malawi / Q000453:epidemiology; D009206:Myocardium / Q000473:pathology; D014566:Urogenital System / Q000469:parasitology / Q000473:pathology
keywords: Africa; Malawi; autopsy; cerebral malaria; pathology; pediatrics