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



Barrera, Valentina, Hiscott, Paul Stephenson ORCID: 0000-0002-4273-2387, Craig, Alister Gordon ORCID: 0000-0003-0914-6164, White, Valerie Ann, Milner, Danny Arnold, Beare, Nicholas Alexander Venton ORCID: 0000-0001-8086-990X, MacCormick, Ian James Callum, Kamiza, Steve, Taylor, Terrie Ellen, Molyneux, Malcolm Edward
et al (show 1 more authors) (2015) Severity of Retinopathy Parallels the Degree of Parasite Sequestration in the Eyes and Brains of Malawian Children With Fatal Cerebral Malaria. Journal of Infectious Diseases, 211 (12). 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
Uncontrolled Keywords: malarial retinopathy, cerebral malaria, Plasmodium falciparum malaria, pediatric coma, clinicopathological correlation, neurovasculature, parasite sequestration, microvascular congestion, vascular pathology, histopathology
Depositing User: Symplectic Admin
Date Deposited: 25 Oct 2017 08:22
Last Modified: 28 Nov 2021 03:11
DOI: 10.1093/infdis/jiu592
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3010824