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Neurovascular sequestration in paediatric P.falciparum malaria is visible clinically in the retina

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Barrera, Valentina, MacCormick, Ian Jc, Czanner, Gabriela, Hiscott, Paul Stephenson, White, Valerie Ann, Craig, Alister ORCID: https://orcid.org/0000-0003-0914-6164, Beare, Nicholas Alexander Venton, Culshaw, Lucy Hazel, Zheng, Yalin, Biddolph, Simon Charles, Milner, Danny A, Kamiza, Steve, Molyneux, Malcolm, Taylor, Terrie E and Harding, Simon Peter (2018) 'Neurovascular sequestration in paediatric P.falciparum malaria is visible clinically in the retina'. eLife, Vol 7, p. 32208.

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Abstract

Retinal vessel changes and retinal whitening, distinctive features of malarial retinopathy, can be directly observed during routine eye examination in children with cerebral malaria. We investigated their clinical significance and underlying mechanisms through linked clinical, clinicopathological and image analysis studies. Orange vessels and severe foveal whitening (clinical examination, n=817, OR, 95% CI: 2.90, 1.96-4.30; 3.4, 1.8-6.3, both p<0.001), and arteriolar involvement by intravascular filling defects (angiographic image analysis, n=260, 2.81, 1.17-6.72, p<0.02) were strongly associated with death. Orange vessels had dense sequestration of late stage parasitised red cells (histopathology, n=29; sensitivity 0.97, specificity 0.89) involving 360° of the lumen circumference, with altered protein expression in blood-retinal barrier cells and marked loss/disruption of pericytes. Retinal whitening was topographically associated with tissue response to hypoxia. Severe neurovascular sequestration is visible at the bedside and is a marker of severe disease useful for diagnosis and management. [Abstract copyright: © 2018, Barrera et al.]

Item Type: Article
Subjects: QX Parasitology > Protozoa > QX 135 Plasmodia
WS Pediatrics > WS 100 General works
WW Ophthalmology > WW 20 Research (General)
WW Ophthalmology > Eye Structures and their Diseases > WW 270 Retina
WW Ophthalmology > Manifestations of Disease. Poor Vision > WW 475 Eye manifestations of general disease
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > Malawi-Liverpool-Wellcome Programme (MLW)
Digital Object Identifer (DOI): https://doi.org/10.7554/eLife.32208
SWORD Depositor: JISC Pubrouter
Depositing User: Stacy Murtagh
Date Deposited: 06 Apr 2018 08:58
Last Modified: 17 Jul 2019 14:15
URI: https://archive.lstmed.ac.uk/id/eprint/8460

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