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Plasmodium falciparum malaria--a diagnostic dilemma
S P Desai1, I M Vora, A M Phatak
1Department of Pathology, T.N. Medical College & B.Y.L. Nair Hospital, Mumbai.
Indian Journal of Pathology & Microbiology
|December 1, 1996
Summary
Autopsy findings reveal that cerebral malaria, characterized by blocked blood vessels, is prevalent in falciparum malaria deaths. Widespread organ damage from infected red blood cells is common, even when peripheral smears are negative.
Area of Science:
- Pathology
- Tropical Medicine
- Infectious Diseases
Background:
- Falciparum malaria is a severe, life-threatening parasitic disease.
- Autopsy studies are crucial for understanding the pathophysiology of fatal malaria cases.
- Cerebral malaria is a major cause of mortality in Plasmodium falciparum infections.
Purpose of the Study:
- To investigate the clinicopathological features of fatal falciparum malaria cases.
- To determine the frequency of cerebral malaria and multi-organ involvement at autopsy.
- To correlate autopsy findings with clinical presentations and outcomes.
Main Methods:
- Retrospective analysis of fifty autopsy cases with confirmed falciparum malaria.
- Histopathological examination of tissue sections from all organs.
- Review of clinical data, including symptoms, diagnosis, and treatment.
Main Results:
- Cerebral malaria was histologically confirmed in 44 cases, with parasitized red blood cells (pRBC) blocking cerebral vasculature in all.
- Multiple organ involvement due to pRBC sequestration was observed in all cases.
- Only 20 cases had positive peripheral blood smears antemortem; 29 patients presented with jaundice, and 18 had altered sensorium, often misdiagnosed as hepatic failure.
Conclusions:
- Histopathological examination is vital for diagnosing cerebral malaria, especially when peripheral smears are negative.
- Sequestration of parasitized erythrocytes in cerebral and other organs is the primary mechanism of death in falciparum malaria.
- Clinical presentation can be misleading, highlighting the importance of autopsy in understanding malaria-related mortality.