Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria

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 sever...

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Main Authors: Arjen 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
Other Authors: Academic Medical Centre, University of Amsterdam
Format: Article
Published: 2018
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Online Access:https://repository.li.mahidol.ac.th/handle/123456789/19845
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spelling th-mahidol.198452018-07-12T09:49:01Z Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria Arjen 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 Academic Medical Centre, University of Amsterdam Mahidol University Mae Sot General Hospital Nuffield Department of Clinical Medicine Dhaka Medical College Chittagong Medical College Hospital Medicine 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. © 2007 by the Infectious Diseases Society of America. All rights reserved. 2018-07-12T02:49:01Z 2018-07-12T02:49:01Z 2008-01-01 Article Journal of Infectious Diseases. Vol.197, No.1 (2008), 79-84 10.1086/523762 00221899 2-s2.0-39349102894 https://repository.li.mahidol.ac.th/handle/123456789/19845 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=39349102894&origin=inward
institution Mahidol University
building Mahidol University Library
continent Asia
country Thailand
Thailand
content_provider Mahidol University Library
collection Mahidol University Institutional Repository
topic Medicine
spellingShingle Medicine
Arjen 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
Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria
description 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. © 2007 by the Infectious Diseases Society of America. All rights reserved.
author2 Academic Medical Centre, University of Amsterdam
author_facet Academic Medical Centre, University of Amsterdam
Arjen 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
format Article
author Arjen 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
author_sort Arjen M. Dondorp
title Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria
title_short Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria
title_full Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria
title_fullStr Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria
title_full_unstemmed Direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria
title_sort direct in vivo assessment of microcirculatory dysfunction in severe falciparum malaria
publishDate 2018
url https://repository.li.mahidol.ac.th/handle/123456789/19845
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