Severe malaria

Abstract

Infection with Plasmodium falciparum induces changes in red blood cells that cause them to adhere to each other and to the endothelium. These changes in the red cells reduce their deformability. Red cells become sequestered in the microcirculation (Fig. 1) where maturation of the parasite occurs prior to haemolysis and infection of new red blood cells. Blockage of the microcirculation by sequestered red cells may result in organ dysfunction and failure, which is responsible for most of the manifestations of severe malaria. Pro-inflammatory cytokines, notably TNF-α, also play an important role in the pathogenesis of severe malaria. Red cell sequestration does not occur with the other plasmodium species and, apart from extremely rare cases, they do not cause severe malaria or death.

CME Vol. 26 (6) 2008: pp. 294-296