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Severity of Retinopathy Parallels the Degree of Parasite Sequestration in the Eyes and Brains of Malawian Children With Fatal Cerebral Malaria

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Barrera, V., Hiscott, P. S., Craig, Alister ORCID: https://orcid.org/0000-0003-0914-6164, White, V. A., Milner, D. A., Beare, N. A. V., MacCormick, I. J. C., Kamiza, S., Taylor, T. E., Molyneux, Malcolm E and Harding, S. P. (2014) 'Severity of Retinopathy Parallels the Degree of Parasite Sequestration in the Eyes and Brains of Malawian Children With Fatal Cerebral Malaria'. Journal of Infectious Disease, Vol 211, Issue 12, pp. 1977-1986.

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Abstract

Background

Malarial retinopathy (MR) has diagnostic and prognostic value in children with Plasmodium falciparum cerebral malaria (CM). A clinicopathological correlation between observed retinal changes during life and the degree of sequestration of parasitized red blood cells was investigated in ocular and cerebral vessels at autopsy.

Methods

In 18 Malawian children who died from clinically defined CM, we studied the intensity of sequestration and the maturity of sequestered parasites in the retina, in nonretinal ocular tissues, and in the brain.

Results

Five children with clinically defined CM during life had other causes of death identified at autopsy, no MR, and scanty intracerebral sequestration. Thirteen children had MR and died from CM. MR severity correlated with percentage of microvessels parasitized in the retina, brain, and nonretinal tissues with some neuroectodermal components (all P < .01). In moderate/severe MR cases (n = 8), vascular congestion was more intense (ρ = 0.841; P < .001), sequestered parasites were more mature, and the quantity of extraerythrocytic hemozoin was higher, compared with mild MR cases (n = 5).

Conclusions

These data provide a histopathological basis for the known correlation between degrees of retinopathy and cerebral dysfunction in CM. In addition to being a valuable tool for clinical diagnosis, retinal observations give important information about neurovascular pathophysiology in pediatric CM.

Item Type: Article
Subjects: QX Parasitology > Protozoa > QX 135 Plasmodia
QY Clinical Pathology > QY 4 General works
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
WS Pediatrics > Diseases of Children and Adolescents > By System > WS 340 Nervous system
WW Ophthalmology > Eye Structures and their Diseases > WW 270 Retina
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1093/infdis/jiu592
Depositing User: Lynn Roberts-Maloney
Date Deposited: 05 Feb 2015 12:29
Last Modified: 17 Jul 2019 14:14
URI: https://archive.lstmed.ac.uk/id/eprint/4828

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