Cerebral Malaria as a Cause of Maternal Mortality in Endemic Areas
P Castillo, C Carrilho, MR Ismail, F Machungo, C Romagosa, A Mayor, C Menendez, J Ordi. Hospital Clinic. CRESIB, Barcelona, Spain; Hospital Central de Maputo, Maputo, Mozambique
Background: Cerebral malaria (CM) is a frequent cause of death in children living in endemic areas. In contrast, in adulthood CM almost exclusively affects non-immune individuals living in non -or low endemic areas. Pregnant women are more susceptible to malaria than non pregnant women or men, and this is due to the presence of a subset of Plasmodium falciparum parasites that adhere to chondroitin sulphate A expressed in trophoblasts and not in other endothelial cells. Malaria in pregnancy is considered to cause severe disease (spontaneous abortion, stillbirth, and CM) only in non-immune women, whereas in semi-immune women from endemic areas, it causes only low birth weight and prematurity in the newborn and anemia in the mother but it is not considered a cause of maternal death. However, there is scant information on the possible role of malaria as cause of death in pregnant women from endemic areas. The aim of this study was to evaluate whether CM is a cause of maternal mortality in endemic areas.
Design: This was a prospective, descriptive study that included all consecutive deaths fulfilling the standard definition of the WHO for a pregnancy-related death in a tertiary level referral hospital in Maputo, Mozambique, between October 2002 and December 2006. A complete dissection with macroscopic evaluation of each organ was performed by a pathologist using a standardized macroscopic protocol. Samples of all grossly identified lesions and of all viscera were collected in each case for histological study.
Results: During the study period, there were 316 complete autopsies of pregnancy-related deaths. CM was identified in 10 cases (3.2%). In all cases massive accumulation of sequestered parasitized erythrocytes were identified in small capillaries in the central nervous system. In all cases most peripheral capillaries from the viscera showed abundant sequestered parasitized erythrocytes. Placenta, which was available in 4 cases showed a massive accumulation of parasites in the maternal erythrocytes in the intervillous space in all cases.
Conclusions: (1) Cerebral malaria is an infrequent (3.2%) but definite cause of maternal mortality in endemic areas; (2) phenotypes of P. falciparum adherent to trophoblast and cerebral capillaries coexist in these patients. Work support in part by grant PI060207 from the Fondo de Investigaciones Sanitarias.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 209, Wednesday Afternoon