**9. Clinical and epidemological findings based on histopathology and immunohistochromatographic detection of p.falciparum antigens**

This new technique for determination of P.falciparum is not adopted during autopsy when actual diagnosis of P.falciparum infestation is missed mostly during improper diagnosis. Many organs and tissues manifest the severity of this type of malaria before death. The heart, lung, liver tissues are always available for post mortem analysis. Some other tissues used include: spleen, kidney, and brain. The following tissues were equally used in a case of five travelers suspected to have died from other chronic diseases not related to malaria. These other tissues include: tongue, trachea, thyroid and adrenal glands, gall bladder and testis. Viral and or bacterial hemorrhagic fever pathogens were suspected at death [23, 24,

25]. In the study, three novel IHC assays targeting HRP 2, aldolase, and pLDH were developed and confirmed on severe P. falciparum infection in five travelers whose deaths were wrongly suspected.

Functions of Dehydrogenases in Health and Disease 179

**Author details** 

**10. References** 

Nwaoguikpe Reginald Nwazue

chemotherapy , 17(6):807-811

malaria. Acta Tropica, 82:51-59

*Department of Biochemistry, Federal, University of Technology, Owerri, Imo State, Nigeria* 

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Malaria is the most common cause of fever in travelers returning to industrialized cities or countries from malaria endemic countries. However, the clinical features of the disease are not specific and in some areas where P.falciparum is not endemic, fatal malaria is often not suspected. The pathological features of malaria resemble many other viral, rikettsial and bacterial infections. An unequivocal diagnosis can be made only by laboratory testing. IHC assays and histopathologic review confirmed P. falciparum infections in many study cases as being responsible for unsuspected deaths. Abundant hemozoin pigment, a by-product of parasite metabolism was distributed diffusely throughout peripheral tissues and in the blood vessels in the central nervous system. The findings are consistent with reports of hemozoin localization. The density of hemozoin increases in proportion to the duration of falciparum infestation and decreases with adequate and appropriate therapy. It has been discovered that the hallmark of P.falciparum infection is sequestration, characterized by the adherence of mature stage falciparum pRBCs(trophozoites and schizonts) to endothelial cells of capillaries and venules.

Many studies in humans and other animals have described sequestration of trophozoites and schizonts in a variety of tissues, including the brain, heart, lung, skeletal muscles and subcutaneous tissues. As a result of sequestration, peripheral blood parasitemia, traditionally evaluated using Geimsa bood smear, may not give substantive correlative result in the pathogenesis of the severity of P. falciparum, hence,the severity of the infection may be underestimated. Plasmodium falciparum infection caused respiratory symptoms that resemble influenza like-illness in correlation with results from studies. There is pulmonary edema with intra-aveolar hyaline membranes and proteinaceous debri, associated with malarial antigens. Pulmonary edema is associated with high parasitemias and often leads to respiratory distress syndrome. Rust tinged urine described for several patients afflicted with this malaria, is associated with hyperbilirubinemia caused by erythrocyte destruction. In many cases of P. falciparum, malarial antigens can be detected in tubular epithelial cells in association with erythrocyte casts. The HRP 2 antibody used in this study was specific for P.falciparum, whereas the aldolase and the pLDH antibodies reacted with both P. falciparum and P. vivax.

In conclusion, the current approach in the diagnosis and development of new drugs for the treatment of Plasmodium falciparum infections is quite novel and holds promise for the future. The ubiquitous nature of the enzyme, Lactate dehydrogenase especially, parasite lactate dehydrogease (pLDH) as malaria antigen, is indicative of the vital biochemical process of metabolism of pyruvate and lactate in microbial cells. The endemic nature of malaria in Africa and some Mediterranean countries poses a great challenge to humanity. There should be a more radical approach especially in Africa and other countries afflicted to tackle this problem which tend to decimate world population. Other frontline drugs which are designed to inhibit the enzyme should be developed to add to the success of this protocol. In as much as mosquitoes have developed resistance against chloroquine, the drug in some places remains the only option for radical cure of malaria.
