Abstract
To study the pathogenesis of fatal cerebral malaria, we conducted autopsies in 31 children with this clinical diagnosis. We found that 23% of the children had actually died from other causes. The remaining patients had parasites sequestered in cerebral capillaries, and 75% of those had additional intra- and perivascular pathology. Retinopathy was the only clinical sign distinguishing malarial from nonmalarial coma. These data have implications for treating malaria patients, designing clinical trials and assessing malaria-specific disease associations.
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Acknowledgements
This work was supported by the US National Institutes of Health (RO1 AO34969) and The Wellcome Trust (042390/Z/94). W.F. is partly supported by the US National Cancer Institute/National Institutes of Health (CA 90301). Many clinicians provided patient care (see Supplementary Note online). For conducting the autopsies, we thank mortuary attendants D. Kotokwa and W. Namanya, and pathologists M. Appleton, D. Barrowcliff, R. Bazinet, D. Connor, T. Kovan, F. MacInnes, H. Manz, D. Milner, A. Oviedo, U. Mahadeva, E. Pollina, C. Richards, C. Richert, L. Stein, R. Tozer, G. Vischer and V. White. We thank the patients' families for the privilege of conducting these autopsies, A. Indurkhya for early statistical input, S. Rogerson for reviewing the manuscript and P. Marsh for nutritional support.
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Taylor, T., Fu, W., Carr, R. et al. Differentiating the pathologies of cerebral malaria by postmortem parasite counts. Nat Med 10, 143–145 (2004). https://doi.org/10.1038/nm986
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DOI: https://doi.org/10.1038/nm986