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



Barrera, Valentina, MacCormick, Ian James Callum, Czanner, Gabriela, Hiscott, Paul Stephenson ORCID: 0000-0002-4273-2387, White, Valerie Ann, Craig, Alister Gordon ORCID: 0000-0003-0914-6164, Beare, Nicholas Alexander Venton ORCID: 0000-0001-8086-990X, Culshaw, Lucy Hazel, Zheng, Yalin ORCID: 0000-0002-7873-0922, Biddolph, Simon Charles
et al (show 5 more authors) (2018) Neurovascular sequestration in paediatric P. falciparum malaria is visible clinically in the retina. eLife, 7.

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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 P. falciparum 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.

Item Type: Article
Depositing User: Symplectic Admin
Date Deposited: 04 Apr 2018 06:22
Last Modified: 22 Jan 2021 12:10
DOI: 10.7554/eLife.32208
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3019756