Pulmonary pathology in pediatric cerebral malaria

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In Vivo Tracking of Edema Development and Microvascular Pathology in a Model of Experimental Cerebral Malaria Using Magnetic Resonance Imaging
09:04

In Vivo Tracking of Edema Development and Microvascular Pathology in a Model of Experimental Cerebral Malaria Using Magnetic Resonance Imaging

Published on: June 8, 2017

Danny Milner1, Rachel Factor, Rich Whitten

  • 1Anatomic & 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.

Human Pathology
|October 1, 2013
PubMed

Insights

Fatal malaria in African children causes respiratory distress not from lung damage, but linked to increased malaria pigment (hemozoin) in cerebral malaria cases. Autopsy findings reveal parasite presence and comorbidities.

Area of Science:

  • Pathology
  • Tropical Medicine
  • Pediatrics

Background:

  • Respiratory signs are frequent in African children in malaria-endemic regions, complicating the assessment of pulmonary pathology.
  • Plasmodium falciparum malaria is a leading cause of death in many African children, often presenting with respiratory symptoms.

Purpose of the Study:

  • To describe the pathological manifestations of fatal malaria in children.
  • To elucidate the roles of malaria parasites, pigment (hemozoin), and macrophages in fatal malaria.
  • To identify and catalog comorbidities associated with fatal malaria.

Main Methods:

  • Examination of lung tissue from 100 children in an autopsy series from Blantyre, Malawi.
  • Inclusion of 55 patients with cerebral malaria and 45 controls (noncerebral malaria and nonmalarial diagnoses).
  • Morphological evaluation and immunohistochemistry on four cores of lung tissue per patient.

Main Results:

  • Large numbers of Plasmodium falciparum parasites and malaria pigment (hemozoin) were observed in pulmonary alveolar capillaries of cerebral malaria patients.
  • Pulmonary macrophage counts did not significantly differ between cerebral malaria, noncerebral malaria, and nonmalarial groups.
  • Comorbidities in cerebral malaria patients included pneumonia, pulmonary edema, hemorrhage, and systemic coagulation activation.

Conclusions:

  • Respiratory distress in cerebral malaria appears unrelated to anatomical lung pathology.
  • Increased malaria pigment (hemozoin) deposition in the lungs is strongly associated with fatal cerebral malaria at autopsy.

Keywords:
AfricaCerebral malariaImmunohistochemistryLungMacrophagesMalariaPediatricTissue arrays

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