A Correlation between Sequestered Parasitized Erythrocytes in Subcutaneous Tissue and Cerebral Malaria

Shusuke NakazawaInstitute of Pathology, Case Western Reserve University, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Cleveland, Ohio, Thailand

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Sornchai LooareesuwanInstitute of Pathology, Case Western Reserve University, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Cleveland, Ohio, Thailand

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Hisashi FujiokaInstitute of Pathology, Case Western Reserve University, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Cleveland, Ohio, Thailand

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Emsri PongponratnInstitute of Pathology, Case Western Reserve University, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Cleveland, Ohio, Thailand

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Kiet dan LucInstitute of Pathology, Case Western Reserve University, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Cleveland, Ohio, Thailand

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John RabbegeInstitute of Pathology, Case Western Reserve University, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Cleveland, Ohio, Thailand

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Masamichi AikawaInstitute of Pathology, Case Western Reserve University, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Cleveland, Ohio, Thailand

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Sequestered parasitized erythrocytes were found in microvessels of subcutaneous tissues in a comatose patient with cerebral malaria even though the blood smears were negative after quinine treatment. This situation reflects the continued presence of sequestered parasites in the brain and suggests that negative parasitemia in peripheral blood does not necessarily mean the end point of malarial treatment has been reached. Our findings suggest that biopsy of subcutaneous tissue from severe malaria patients may be useful for determining the severity and prognosis of malaria patients.

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