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. 2007 Feb 15;195(4):589-96.
doi: 10.1086/510756. Epub 2007 Jan 4.

Lung injury in vivax malaria: pathophysiological evidence for pulmonary vascular sequestration and posttreatment alveolar-capillary inflammation

Nicholas M Anstey  1 , Tjandra Handojo, Michael C F Pain, Enny Kenangalem, Emiliana Tjitra, Ric N Price, Graeme P Maguire
Affiliations

Lung injury in vivax malaria: pathophysiological evidence for pulmonary vascular sequestration and posttreatment alveolar-capillary inflammation

Nicholas M Anstey et al. J Infect Dis. .

Abstract

Background: The mechanisms underlying lung injury in vivax malaria are not well understood. Inflammatory responses to Plasmodium falciparum and P. vivax, to our knowledge, have not previously been compared at an organ level.

Methods: Respiratory symptoms and physiological aspects were measured longitudinally in Indonesian adults with uncomplicated vivax (n=50) and falciparum (n=50) malaria. Normal values were derived from 109 control subjects. Gas transfer was partitioned into its alveolar-capillary membrane (D(M)) and pulmonary capillary vascular (V(C)) components, to characterize the site and timing of impaired gas transfer.

Results: Mean baseline V(C) volume was significantly reduced in vivax and falciparum malaria, improving with treatment in each species. Baseline D(M) function was not impaired in either species. The progressive deterioration in D(M) function after treatment was statistically significant in vivax malaria but not in uncomplicated falciparum malaria. Oxygen saturation deteriorated after treatment in vivax but improved in falciparum malaria.

Conclusions: The baseline reduction in V(C) volume but not in D(M) function suggests encroachment on V(C) volume by parasitized erythrocytes and suggests that P. vivax-infected erythrocytes may sequester within the pulmonary microvasculature. Progressive alveolar-capillary dysfunction after treatment of vivax malaria is consistent with a greater inflammatory response to a given parasite burden in P. vivax relative to that in P. falciparum.

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Figures

Figure 1
Figure 1
Proportions of patients with uncomplicated vivax and falciparum malaria with cough, over time, compared with that of control subjects. The whiskers denote 95% confidence intervals. *P< .05, χ2 test; **P< .01, χ2 test.
Figure 2
Figure 2
Gas transfer (DLCO) measures over time for patients with uncomplicated vivax and falciparum malaria. Data are mean percentages of predicted values and SE values. Black bars represent the control subjects, gray bars represent patients with uncomplicated vivax malaria, and white bars indicate patients with uncomplicated falciparum malaria. Comparison with controls: *P< .05; **P< .01. Linear regression coefficient for the decrease in the alveolar-capillary membranous component of DLCO (DM) in Plasmodium vivax: −1.0% of predicted value/day; P = .02, r2 = .10. The decrease in DM function in P. falciparum was not statistically significant. VC, pulmonary capillary vascular component of DLCO.
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References

    1. Hay SI, Guerra CA, Tatem AJ, Noor AM, Snow RW. The global distribution and population at risk of malaria: past, present, and future. Lancet Infect Dis. 2004;4:327–36. - PMC - PubMed
    1. Price RN, Tjitra E, White NJ, Anstey NM. Vivax malaria: neglected and not benign. Am J Trop Med Hyg. in press. - PMC - PubMed
    1. Nosten F, McGready R, Simpson JA, et al. Effects of Plasmodium vivax malaria in pregnancy. Lancet. 1999;354:546–9. - PubMed
    1. Chotinavich K, Udomsangpetch R, Pukrittayakamee S, et al. The adhesion receptors of P. vivax-infected red cells (abstract P27) Exp Parasitol. 2003;105:33–4.
    1. McGready R, Davison BB, Stepniewska K, et al. The effects of Plasmodium falciparum and P. vivax infections on placental histopathology in an area of low malaria transmission. Am J Trop Med Hyg. 2004;70:398–407. - PubMed

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