Postmortem Characterization of Patients With Clinical Diagnosis of Plasmodium vivax Malaria: To What Extent Does This Parasite Kill?
Postmortem Characterization of Patients With Clinical Diagnosis of Plasmodium vivax Malaria: To What Extent Does This Parasite Kill?
复制标题
间日疟原虫疟疾临床诊断患者的尸检特征：这种寄生虫的杀伤力有多大？
DOI：
10.1093/cid/cis615
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发表时间：
2012-10-15
影响因子：
11.8
通讯作者：
Bassat, Quique
中科院分区：
文献类型：
--
作者：
Lacerda, Marcus V. G.;Fragoso, Silvio C. P.;Bassat, Quique
背景。归因于疟原虫感染的严重疾病已经在全球范围内得到很好的描述。但是，这些患者的尸检是稀缺的。从1996年到2010年，在巴西亚马逊的三级护理中心发生了19例患有临床诊断的患者。这19例死亡中有17人完全尸检。检索了临床图表，宏观尸检报告和存储的石蜡组织块。嵌套聚合酶链反应在脾脏和肺的石蜡样品中进行，以证实假子单感染。免疫疗法荧光用于检测寄生的红细胞（RBC）。在17个尸检中，有13个揭示死亡可能归因于Vivax感染。在其余的4例中，发现疟疾以外的其他急性疾病是死亡的原因。疟疾导致死亡的患者的主要并发症是急性呼吸窘迫综合征（ARDS）和与中性粒细胞在肺泡空间中积累相关的肺水肿（6例）。脾脏破裂（3例）和多器官功能障碍综合征（3例）是第二常见的并发症。还表征了一个因昏迷而发展的孩子，但在脑组织中未检测到寄生虫。在一名出现ARD并在死亡时出现阴性的外周寄生虫血症的患者中，在肺毛细血管中看到了散射的寄生红细胞，这表明肺部有些隔离。在17例死者中的13例中，体内疟原虫感染是可行的死亡原因。但是，需要更多的研究来了解与严重疾病有关的发病机理。
Background. Severe disease attributable to Plasmodium vivax infection is already well described worldwide; however, autopsies in these patients are scarce.Methods. From 1996 to 2010, 19 patient deaths with a clinical diagnosis of P. vivax infection occurred in a tertiary care center in the Brazilian Amazon. Seventeen of these 19 deaths were fully autopsied. Clinical charts, macroscopic autopsy reports, and stored paraffinized tissue blocks were retrieved. Nested polymerase chain reaction was performed in paraffinized samples of spleen and lung to confirm P. vivax monoinfection. Immunohistofluorescence was used to detect P. vivax parasitized red blood cells (RBCs).Results. Of 17 autopsies, 13 revealed that death could be attributed to P. vivax infection; in the remaining 4, acute diseases other than malaria were found to be the cause of death. The primary complication in patients in which malaria contributed to death was acute respiratory distress syndrome (ARDS) and pulmonary edema associated with the accumulation of neutrophils in the interalveolar space (6 cases). Spleen rupture (3 cases) and multiorgan dysfunction syndrome (3 cases) were the second most common complications. One child evolving with coma was also characterized, but no parasite was detected in the brain tissue. In one patient who developed ARDS and presented negative peripheral parasitemia by the time of death, scattered parasitized red blood cells were seen inside pulmonary capillaries, suggesting some sequestration in the lung.Conclusions. In 13 of 17 deceased patients, P. vivax infection was the plausible cause of death. However, more studies are needed to understand pathogenesis related to severe disease.