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Increased cerebrospinal fluid protein and lipid peroxidation products in patients with cerebral malaria
B S Das1, S Mohanty, S K Mishra
1Department of Biochemistry, Ispat General Hospital, Orissa, India.
Abstract:
Membrane lipid peroxidation by reactive oxygen species leading to increased capillary permeability is considered an important event in the pathogenesis of severe malaria. A significant decrease in plasma albumin and increases in cerebrospinal fluid (CSF) protein and malondialdehyde (MDA) were observed in 73 patients with cerebral malaria, compared to values in 23 control patients. The greatest effect was noticed in the most severely ill patients. The ratio of CSF protein to plasma albumin was increased in the patients compared to the controls, and in fatal cases of cerebral malaria compared to non-fatal cases. Brain necropsies showed oedema, fibrin deposits and mononuclear cell infiltration. It is proposed that cerebral oedema due to enhanced permeability of vascular endothelium induced by increased lipid peroxidation plays a crucial role in the causation of cerebral malaria.
Insights
Severe malaria causes increased lipid peroxidation, damaging capillaries and leading to cerebral edema. This study links increased protein in cerebrospinal fluid and decreased plasma albumin to severe malaria pathogenesis.
Area of Science:
- Neurology
- Pathology
- Biochemistry
Background:
- Membrane lipid peroxidation by reactive oxygen species increases capillary permeability, a key factor in severe malaria pathogenesis.
- Cerebral malaria is a severe complication of malaria, often leading to neurological deficits and mortality.
Purpose of the Study:
- To investigate the role of lipid peroxidation and its consequences in the pathogenesis of cerebral malaria.
- To correlate biochemical markers with disease severity and outcomes in cerebral malaria patients.
Main Methods:
- Analysis of plasma albumin, cerebrospinal fluid (CSF) protein, and malondialdehyde (MDA) levels in 73 cerebral malaria patients and 23 controls.
- Comparison of biochemical markers between different severity groups and fatal vs. non-fatal cases.
- Examination of brain necropsy findings in fatal cases.
Main Results:
- Patients with cerebral malaria showed decreased plasma albumin and increased CSF protein and MDA compared to controls.
- Biochemical alterations were most pronounced in the most severely ill patients.
- Increased CSF protein to plasma albumin ratio was observed in patients and was higher in fatal cases. Brain necropsies revealed edema, fibrin deposits, and inflammation.
Conclusions:
- Increased lipid peroxidation contributes to enhanced vascular permeability and cerebral edema in cerebral malaria.
- Biochemical markers like CSF protein and MDA levels correlate with disease severity and outcome.
- Cerebral edema, driven by lipid peroxidation-induced endothelial dysfunction, is proposed as a critical factor in cerebral malaria causation.