Retention of erythrocytes in the spleen: a double-edged process in human malaria
Retention of erythrocytes in the spleen: a double-edged process in human malaria
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DOI：
10.1097/moh.0b013e32832a1d4b
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发表时间：
2009-05-01
影响因子：
3.2
通讯作者：
David, Peter H.
中科院分区：
文献类型：
--
作者：
Buffet, Pierre A.;Safeukui, Innocent;David, Peter H.
脾肿大是常见的急性或慢性形式的恶性疟原虫疟疾，脾切除术是与更频繁的发热和寄生虫血症。最近的流行病学和实验数据表明，一个新的作用，脾脏在疟疾，带来了一个新的范式严重的疟疾pathogenicity.Recent findingsIn苏丹儿童，严重的疟疾性贫血与较大的脾脏，较长的发热时间，和较低的parasitaemia比脑型疟疾。这些发现与向严重疟疾贫血的演变相一致，该严重疟疾贫血与脑型疟疾中缺乏或效率低下的脾依赖性机制的存在有关。一个孤立的灌注人脾模型揭示了意想不到的保留许多红细胞窝藏年轻的寄生虫阶段（环），可能通过一个先天的mechanical processe.SummaryA新的范例进行了讨论，从而红细胞保留在脾脏条件的程度不仅血红蛋白浓度和脾脏大小，但也寄生虫负荷增加的速度。预测是，在非免疫儿童中，严格的脾保留环和未感染的红细胞降低了脑型疟疾（与高寄生虫负荷相关的并发症）的风险，但增加了严重疟疾贫血的风险。这一假说为疟疾发病机制的流行病学、遗传学和实验研究提供了新的思路。
Purpose of reviewSplenomegaly is frequent in acute or chronic forms of Plasmodium falciparum malaria, and splenectomy is associated with more frequent fever and parasitaemia. A novel role for the spleen in malaria is indicated by recent epidemiological and experimental data, bringing about a novel paradigm on severe malaria pathogenesis.Recent findingsIn Sudanese children, severe malarial anaemia was associated with larger spleen, longer fever duration, and lower parasitaemia than cerebral malaria. These findings are consistent with evolution toward severe malarial anaemia being linked to the presence of a spleen-dependent mechanism that is absent or inefficient in cerebral malaria. An isolated - perfused human spleen model revealed unexpected retention of numerous erythrocytes harbouring young parasite stages (rings), probably through an innate mechanical process.SummaryA new paradigm is discussed, whereby the extent of erythrocyte retention in the spleen conditions not only haemoglobin concentration and spleen size but also the rate of parasite load increase. The prediction is that, in nonimmune children, stringent splenic retention of rings and uninfected erythrocytes reduces the risk of cerebral malaria (a complication associated with high parasite loads) but increases the risk of severe malarial anaemia. This hypothesis casts new light on epidemiological, genetic, and experimental studies in malaria pathogenesis.