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Poster Session C50: Infections and Inflammation

The aim of this study was to assess vascular changes and cellular damage in cerebral malaria at different stages of disease progression. Five brains of French patients who died from Plasmodium falciparum infection (2 cases within one week of symptoms, 3 following 3 to 9 weeks of disease) were examined. All patients died from severe multi-organ failure, associated in 4 cases with disrupted hemostasis. On histology, all 5 cases had microscopic ischaemic lesions. Malaria pigment was observed in 2 cases with rapid evolution. The 3 other cases with prolonged disease evolution showed no gross abnormality. Expression of vascular markers on paraffin sections (factor VIII, CD34) was conserved and there was no significant upregulation of adhesion proteins CD31, alpha and beta cathenins. Contrasting with the extent of cellular damage, internucleosomal fragmentation of DNA assessed by TUNEL was infrequent. Accumulation of poly(ADP-ribose) (PARP), a DNA repair zinc-finger protein, assessed by immunohistochemistry, predominated in glial cells especially in the white matter. However there was no correlation between the severity of parasite sequestration and the extent of nuclear fragmentation or the up-regulation of DNA repair proteins.