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Trends Parasitol. 2013 Dec;29(12):585-92. doi: 10.1016/j.pt.2013.10.004. Epub 2013 Nov 5.

Stuck in a rut? Reconsidering the role of parasite sequestration in severe malaria syndromes.

Author information

1
Section of Paediatrics, Imperial College, Norfolk Place, London W2 1PG, UK. Electronic address: a.cunnington@imperial.ac.uk.

Abstract

Severe malaria defines individuals at increased risk of death from their infection. Proposed pathogenic mechanisms include parasite sequestration, inflammation, and endothelial dysfunction. Severe malaria is not a single entity, manifesting with distinct syndromes such as severe anemia, severe respiratory distress or coma, each characterized by differences in epidemiology, underlying biology, and risk of death. The relative contribution of the various pathogenic mechanisms may differ between syndromes, and this is supported by accumulating evidence, which challenges sequestration as the initiating event. Here we propose that high parasite biomass is the common initiating feature, but subtle variations in the interaction between the host and parasite exist, and understanding these differences may be crucial to improve outcomes in patients with severe malaria.

KEYWORDS:

biomass; endothelial activation; inflammation; sequestration; severe malaria

PMID:
24210256
PMCID:
PMC3880783
DOI:
10.1016/j.pt.2013.10.004
[Indexed for MEDLINE]
Free PMC Article

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