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Supraorbital Postmortem Brain Sampling for Definitive Quantitative Confirmation of Cerebral Sequestration of Plasmodium falciparum Parasites

Milner, D. A., Valim, C., Luo, R., Playforth, K. B., Kamiza, S., Molyneux, Malcolm E, Seydel, K. B. and Taylor, T. E. (2012) 'Supraorbital Postmortem Brain Sampling for Definitive Quantitative Confirmation of Cerebral Sequestration of Plasmodium falciparum Parasites'. Journal of Infectious Disease, Vol 205, Issue 10, pp. 1601-1606.

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Abstract

Background
The conventional clinical case definition of cerebral malaria (CM) is imprecise but specificity is improved by a definitive clinical feature such as retinopathy or confirming sequestration of parasites in a post-mortem examination of the brain. A full autopsy is often not possible, since it is costly and may encounter resistance of the deceased's family.

Methods
We have assessed the use of a cytological smear of brain tissue, obtained post-mortem by supraorbital sampling, for the purpose of quantifying cerebral sequestration in children with fatal malaria in Blantyre, Malawi. We have compared this method to histological quantification of parasites at autopsy.

Results
The number of parasites present on cytological smears correlated with the proportion of vessels parasitized as assessed by histology of fixed and stained brain tissue. Use of cytological results in addition to the standard clinical case definition increases the specificity of the clinical case definition alone from 48.3% to 100% with a minimal change in sensitivity.

Conclusions
Post-mortem supraorbital sampling of brain tissue improves the specificity of the diagnosis of fatal cerebral malaria and provides accurate quantitative estimates of cerebral sequestration. This tool can be of great value in clinical, pathogenetic, and epidemiological research studies on cerebral malaria.

Item Type: Article
Subjects: QX Parasitology > Protozoa > QX 135 Plasmodia
QX Parasitology > QX 20 Research (General)
QZ Pathology > QZ 35 Postmortem examination
QZ Pathology > Pathogenesis. Etiology > QZ 40 Pathogenesis. Etiology
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
Digital Object Identifer (DOI): https://doi.org/10.1093/infdis/jis001
Depositing User: Lynn Roberts-Maloney
Date Deposited: 28 Jan 2015 10:12
Last Modified: 07 Dec 2018 09:48
URI: https://archive.lstmed.ac.uk/id/eprint/4802

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