| Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria. | |
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MedLine Citation:
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PMID: 18171289 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: This study sought to describe and quantify microcirculatory changes in the mucosal surfaces of patients with severe malaria, by direct in vivo observation using orthogonal polarization spectral (OPS) imaging. METHODS: The microcirculation in the rectal mucosa of adult patients with severe malaria was assessed by use of OPS imaging, at admission and then daily. Comparison groups comprised patients with uncomplicated falciparum malaria, patients with bacterial sepsis, and healthy individuals. RESULTS: Erythrocyte velocities were measured directly in 43 adult patients with severe falciparum malaria, of whom 20 died. Microcirculatory blood flow was markedly disturbed, with heterogeneous obstruction that was proportional to severity of disease. Blocked capillaries were found in 29 patients (67%) and were associated with concurrent hyperdynamic blood flow (erythrocyte velocity, >750 mm/s) in adjacent vessels in 27 patients (93%). The proportion of blocked capillaries correlated with the base deficit in plasma and with the concentration of lactate. Abnormalities disappeared when the patients recovered. In healthy individuals and in patients with uncomplicated malaria or sepsis, no stagnant erythrocytes were detected, and, in patients with sepsis, hyperdynamic blood flow was prominent. CONCLUSION: Patients with severe falciparum malaria show extensive microvascular obstruction that is proportional to the severity of the disease. This finding underscores the prominent role that microvascular obstruction plays in the pathophysiology of severe malaria and illustrates the fundamental difference between the microvascular pathophysiology of malaria and that of bacterial sepsis. |
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Authors:
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A M Dondorp; C Ince; P Charunwatthana; J Hanson; A van Kuijen; M A Faiz; M R Rahman; M Hasan; E Bin Yunus; A Ghose; R Ruangveerayut; D Limmathurotsakul; K Mathura; N J White; N P J Day |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of infectious diseases Volume: 197 ISSN: 0022-1899 ISO Abbreviation: J. Infect. Dis. Publication Date: 2008 Jan |
Date Detail:
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Created Date: 2008-01-03 Completed Date: 2008-03-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0413675 Medline TA: J Infect Dis Country: United States |
Other Details:
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Languages: eng Pagination: 79-84 Citation Subset: AIM; IM |
Affiliation:
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Department of Physiology, Academic Medical Centre, Amsterdam, The Netherlands. arjen@tropmedres.ac |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Animals Blood Flow Velocity Female Hemorheology / methods Humans Intestinal Mucosa / blood supply*, physiopathology Malaria, Falciparum / physiopathology* Male Microcirculation / physiopathology* Microscopic Angioscopy / methods Microscopy, Polarization Middle Aged Mouth Mucosa / blood supply*, physiopathology Rectum / blood supply*, physiopathology |
| Grant Support | |
ID/Acronym/Agency:
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//Wellcome Trust |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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