The bone marrow in human cerebral malaria: parasite sequestration within sinusoids

Area of Science:

• Hematology
• Pathology
• Infectious Diseases

Background:

• Cerebral malaria is a severe complication of Plasmodium falciparum infection.
• Bone marrow dysfunction is observed in severe malaria but its mechanisms are not fully understood.

Purpose of the Study:

• To investigate the ultrastructural changes in the bone marrow of patients with cerebral malaria.
• To elucidate the role of bone marrow pathology in the pathogenesis of cerebral malaria.

Main Methods:

• Bone marrow aspirates from cerebral malaria patients were examined using light and electron microscopy.
• Morphological analysis focused on cellular abnormalities and interactions between parasitized red blood cells and bone marrow endothelium.

Main Results:

• Observed were increased plasma cells, macrophages, and eosinophils, along with abnormal erythroblasts.
• Parasitized red blood cells adhered to and obstructed marrow sinusoids, with evidence of sequestration and extravasation.
• Complex interdigitations between parasitized red cells and endothelial cells were noted, suggesting intimate interaction.

Conclusions:

• Bone marrow pathology in cerebral malaria involves significant cellular changes and obstruction of sinusoids by parasitized red blood cells.
• Sequestration of parasitized red blood cells within the bone marrow may contribute to both cerebral complications and overall disease severity.