ABSTRACT
We describe a severely immunosuppressed HIV-1-positive man in whom immune restoration disease associated with pulmonary infection caused by Mycobacterium microti developed after antiretroviral treatment. The diagnosis was made by using convenient spoligotyping techniques, but invasive investigations were required to exclude a tumor.
Subject(s)
HIV Infections/complications , HIV Infections/immunology , Mycobacterium Infections/complications , Mycobacterium Infections/immunology , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/immunology , AIDS-Related Opportunistic Infections/microbiology , Adult , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Antitubercular Agents/therapeutic use , HIV Infections/drug therapy , Humans , Male , Mycobacterium/isolation & purification , Mycobacterium Infections/diagnosis , Mycobacterium Infections/drug therapyABSTRACT
Cerebral malaria is the most severe neurological complication of Plasmodium falciparum malaria. Even though this type of malaria is most common in children living in sub-Saharan Africa, it should be considered in anybody with impaired consciousness that has recently travelled in a malaria-endemic area. Cerebral malaria has few specific features, but there are differences in clinical presentation between African children and non-immune adults. Subsequent neurological impairments are also most common and severe in children. Sequestration of infected erythrocytes within cerebral blood vessels seems to be an essential component of the pathogenesis. However, other factors such as convulsions, acidosis, or hypoglycaemia can impair consciousness. In this review, we describe the clinical features and epidemiology of cerebral malaria. We highlight recent insights provided by ex-vivo work on sequestration and examination of pathological specimens. We also summarise recent studies of persisting neurocognitive impairments in children who survive cerebral malaria and suggest areas for further research.
Subject(s)
Malaria, Cerebral/physiopathology , Outcome Assessment, Health Care , Plasmodium falciparum/pathogenicity , Age Factors , Animals , Brain/diagnostic imaging , Brain/parasitology , Brain/pathology , Cerebral Infarction/parasitology , Cerebral Infarction/pathology , Erythrocytes/parasitology , Erythrocytes/pathology , Humans , Malaria, Cerebral/epidemiology , Models, Biological , Radiography , Retina/microbiology , Retina/pathologyABSTRACT
An intercellular adhesion molecule-1 polymorphism (ICAM-1(Kilifi)) is present at a high frequency across sub-Saharan Africa, and its presence may increase susceptibility to cerebral malaria. Here, we report that, compared with children in whom wild-type intercellular adhesion molecule-1 is present, the incidence of nonmalarial fever is significantly lower among those homozygous for ICAM-1(Kilifi). We propose that ICAM-1(Kilifi) may be associated with reduced rates of tissue damage and of death due to sepsis.
