Table 3 Evidence of blood–brain barrier (BBB) impairment in human cerebral malaria (CM) patients

Thai patients

P. falciparum

157

Albumin CSF/serum ratio

BBB intact

[126]

Vietnamese patients

P. falciparum

20

Albumin and Immunoglobulins G plasma/CSF ratios

Minimal BBB breakdown in a few cases of CM

[127]

Zairean children

P. falciparum

21

Albumin CSF/serum ratio

BBB not impaired

[128]

Malawian children

P. falciparum

72

Immunohistochemistry on autopsy brain tissues

Disruption of endothelial intercellular junctions and impaired BBB function

[129]

Kenyan children

P. falciparum

100

Protein and immunoglobulin CSF/serum ratio

Mild BBB impairment in some cases

[130]

Malawian children

P. falciparum

50

Immunohistochemistry on autopsy brain tissues

BBB breakdown

[131]

Nigerian children

P. falciparum

61

Examination of the possible risk factors for poor prognosis and studies on post mortem samples

Cerebral edema and raised intracranial pressure in 50%

[132]

Thai and Vietnamese children

P. falciparum

65

Studies on post mortem samples

Cerebral sequestration of P. falciparum-infected erythrocytes

[133]

Vietnamese patients

P. falciparum

20

Studies on post mortem samples

Heterogeneous cerebral edema and plasma protein leakage

[134]

Vietnamese adults and Malawian children

P. falciparum

14

Immunohistochemistry

Alteration of cell junction proteins occludin, vinculin and ZO-1

[135]

Kenyan children

P. falciparum

14

Computed tomography

Cerebral edema and ischemia

[136]

French adults back from Cameroon, Niger, and Thailand

P. falciparum

3

Magnetic resonance

Hemorrhagic cortical lesions

[137]

Malian children

P. falciparum

8

Computed tomography

Diffuse atrophy with asymmetrical ventricle dilation, suggesting limited CSF circulation

[138]

French adult back from Equatorial Guinea

P. falciparum

1

Magnetic resonance

BBB breakdown

[140]

Malawian children

P. falciparum

14

Computed tomography

Fatal CM: cerebral edema, large vessel infarcts; Non fatal CM with neurological sequelae: focal/multifocal atrophy

[141]

Indian adults

P. falciparum

4

Magnetic resonance

Bithalamic infarctions with or without haemorrages

[142]

Malawian children

P. falciparum

120

Magnetic resonance

increased brain volume; abnormalities in cortical, deep gray, and white matter structures

[143]

Malawian children

P. falciparum

38

Magnetic resonance

periventricular and subcorical T2 signal changes, atrophy, and focal cortical defects