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Expression of Merozoite Surface Protein Markers by Plasmodium falciparum-Infected Erythrocytes in Peripheral Blood and Tissues of Children with Fatal Malaria

Carlota Dobaño,^1,2* Stephen J. Rogerson,^3,4, Terrie E. Taylor,^5,6 Jana S. McBride,¹ and Malcolm E. Molyneux^3,4

Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, Scotland,¹ Centre de Salut Internacional, Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain,² Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi,³ Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, United Kingdom,⁴ Blantyre Malaria Project, University of Malawi College of Medicine, Blantyre, Malawi,⁵ College of Osteopathic Medicine, Michigan State University, East Lansing Michigan⁶

Received 22 September 2006/ Returned for modification 16 October 2006/ Accepted 7 November 2006

Sequestration of Plasmodium falciparum-infected erythrocytes is a pathological feature of fatal cerebral malaria. P. falciparum is genetically diverse among, and often within, patients. Preferential sequestration of certain genotypes might be important in pathogenesis. We compared circulating parasites with parasites sequestered in the brain, spleen, liver, and lung in the same Malawian children with fatal malaria, classifying serotypes using antibodies to merozoite surface proteins 1 and 2 and immunofluorescence in order to differentiate parasites and to quantify the proportions of each serotype. We found (i) similar distributions of various serotypes in different tissues and (ii) concordance between parasite serotypes in peripheral blood and parasite serotypes in tissues. No serotypes predominated in the brain in cerebral malaria, and parasites belonging to a single serotype did not cluster within individual vessels or within single tissues. These findings do not support the hypothesis that cerebral malaria is caused by cerebral sequestration of certain virulent types.

Published ahead of print on 21 November 2006.

Editor: W. A. Petri, Jr.

Present address: Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville VIC, Australia.

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