The eye in cerebral malaria: what can it teach us?
The eye in cerebral malaria: what can it teach us?
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DOI：
10.1016/j.trstmh.2008.11.003
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发表时间：
2009-07
影响因子：
2.2
通讯作者：
Beare NA
中科院分区：
文献类型：
--
作者：
Maude RJ;Dondorp AM;Abu Sayeed A;Day NP;White NJ;Beare NA
脑型疟疾（CM）昏迷的病理生理学尚不清楚。微循环流动的阻塞被认为起着核心作用，但其他假设包括寄生虫和宿主衍生因素（如免疫介质）的作用，以及血脑屏障通透性增加导致颅内压升高的作用。视网膜脉管系统是脑脉管系统的直接延伸。它是唯一易于可视化的血管床，并提供了观察血管病理及其对神经组织影响的独特机会。在患有 CM 的非洲儿童中，一种特定的视网膜病变已得到充分描述，其严重程度与结果相关。这种成人视网膜病变的描述还不太清楚。引起疟疾视网膜病变的核心机制似乎是微血管阻塞，这已通过荧光素血管造影在受影响的视网膜中得到证实。中枢神经系统组织中微血管阻塞的存在有力地支持了这样的假设：红细胞在小血管中的隔离以及随后的微循环流动阻塞是引起CM中昏迷和死亡的重要机制。尽管重症疟疾的抗疟治疗取得了进展，但其死亡率仍然约为 15-20%。针对隔离的辅助治疗是进一步降低死亡率的有前途的策略。
The pathophysiology of coma in cerebral malaria (CM) is not well understood. Obstruction of microcirculatory flow is thought to play a central role, but other hypotheses include roles for parasite- and host-derived factors such as immune mediators, and for increased blood–brain barrier permeability leading to raised intracranial pressure. The retinal vasculature is a direct extension of the cerebral vasculature. It is the only vascular bed easily accessible for visualisation and provides a unique opportunity to observe vascular pathology and its effect on neurological tissue. A specific retinopathy has been well described in African children with CM and its severity correlates with outcome. This retinopathy has been less well described in adults. The central mechanism causing malarial retinopathy appears to be microvascular obstruction, which has been demonstrated in affected retinas by fluorescein angiography. The presence in a central nervous system tissue of microvascular obstruction strongly supports the hypothesis that the sequestration of erythrocytes in small blood vessels and consequent obstruction of microcirculatory flow is an important mechanism causing coma and death in CM. Despite advances in the antimalarial treatment of severe malaria, its mortality remains approximately 15–20%. Adjunctive treatment targeting sequestration is a promising strategy to further lower mortality.
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DOI：
10.1016/s0035-9203(99)90071-8
发表时间：
1999-11-01
影响因子：
2.2
作者：
Lewallen, S;Harding, SP;Taylor, TE
通讯作者：
Taylor, TE
影响因子：
--
作者：
Beare, NA;Southern, C;Harding, SP
通讯作者：
Harding, SP
DOI：
10.4269/ajtmh.1983.32.911
发表时间：
1983-01-01
影响因子：
3.3
作者：
LOOAREESUWAN, S;WARRELL, DA;KANCHANARANYA, C
通讯作者：
KANCHANARANYA, C
影响因子：
2.7
作者：
Dondorp, AM;Pongponratn, E;White, NJ
通讯作者：
White, NJ
影响因子：
--
作者：
Beare, NA;Southern, C;Harding, SP
通讯作者：
Harding, SP