Retinal pathology of pediatric cerebral malaria in Malawi.
Retinal pathology of pediatric cerebral malaria in Malawi.
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DOI：
10.1371/journal.pone.0004317
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发表时间：
2009
期刊：
影响因子：
3.7
通讯作者：
Taylor TE
中科院分区：
文献类型：
--
作者：
White VA;Lewallen S;Beare NA;Molyneux ME;Taylor TE
脑型疟疾昏迷和死亡的原因仍然不明。疟疾视网膜病变已被确定为脑型疟疾诊断和预后的重要临床体征。作为一个更大的尸检研究的一部分，以确定在布兰太尔，马拉维，谁是充分的临床评估之前，医院昏迷的儿童死亡的原因，我们检查了眼睛的组织病理学死亡和尸检的患者。昏迷的儿童被送入儿科研究病房，根据临床定义分类为患有脑型疟疾或其他昏迷原因，进行评估和治疗。通过直接和间接检眼镜检查眼睛。如果一个孩子死亡，并得到许可，进行标准化的尸检。然后根据尸检结果为患者指定实际死亡原因。对眼睛进行病理学检查，检查是否有水肿、囊样黄斑水肿、寄生虫隔离和血栓。对它们进行纤维蛋白和CD 61的化学染色以鉴定血栓的组分，β-淀粉样前体蛋白以检测轴突损伤，纤维蛋白原以鉴定血管渗漏，胶质细胞酸性蛋白以检测胶质增生。对64例患者的64只眼进行了检查：35例脑型疟疾患者和29例其他原因昏迷患者。脑型疟疾的区别在于寄生红细胞的隔离、视网膜病变的存在和严重程度、黄斑囊样水肿的存在、纤维蛋白-血小板血栓的发生和数量、轴突损伤和血管渗漏的存在和数量。我们发现死于脑型疟疾的患者和其他诊断的患者在视网膜组织病理学上有显著差异。这些组织病理学的发现提供了深入了解疟疾视网膜病变的病因，并提供了一个病理基础，最近描述的视网膜毛细血管非灌注儿童疟疾视网膜病变。由于视网膜和大脑之间的相似性，它也表明了可能导致脑型疟疾昏迷和死亡的机制。
The causes of coma and death in cerebral malaria remain unknown. Malarial retinopathy has been identified as an important clinical sign in the diagnosis and prognosis of cerebral malaria. As part of a larger autopsy study to determine causes of death in children with coma presenting to hospital in Blantyre, Malawi, who were fully evaluated clinically prior to death, we examined the histopathology of eyes of patients who died and underwent autopsy. Children with coma were admitted to the pediatric research ward, classified according to clinical definitions as having cerebral malaria or another cause of coma, evaluated and treated. The eyes were examined by direct and indirect ophthalmoscopy. If a child died and permission was given, a standardized autopsy was carried out. The patient was then assigned an actual cause of death according to the autopsy findings. The eyes were examined pathologically for hemorrhages, cystoid macular edema, parasite sequestration and thrombi. They were stained immunohistochemically for fibrin and CD61 to identify the components of thrombi, β-amyloid precursor protein to detect axonal damage, for fibrinogen to identify vascular leakage and for glial fibrillary acidic protein to detect gliosis. Sixty-four eyes from 64 patients were examined: 35 with cerebral malaria and 29 with comas of other causes. Cerebral malaria was distinguished by sequestration of parasitized erythrocytes, the presence and severity of retinal hemorrhages, the presence of cystoid macular edema, the occurrence and number of fibrin-platelet thrombi, the presence and amount of axonal damage and vascular leakage. We found significant differences in retinal histopathology between patients who died of cerebral malaria and those with other diagnoses. These histopathological findings offer insights into the etiology of malarial retinopathy and provide a pathological basis for recently described retinal capillary non-perfusion in children with malarial retinopathy. Because of the similarities between the retina and the brain it also suggests mechanisms that may contribute to coma and death in cerebral malaria.
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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：
6.4
作者：
Grau, GE;Mackenzie, CD;Molyneux, ME
通讯作者：
Molyneux, ME
影响因子：
--
作者：
Beare, NA;Southern, C;Harding, SP
通讯作者：
Harding, SP
影响因子：
0.6
作者：
Harding, S. P.;Lewallen, S.;Molyneux, M. E.
通讯作者：
Molyneux, M. E.
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