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. e32208-.

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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
Uncontrolled Keywords: Retinal Vessels, Macula Lutea, Humans, Malaria, Falciparum, Retinal Diseases, Angiography, Sensitivity and Specificity, Image Processing, Computer-Assisted, Child, Preschool, Female, Male
Depositing User: Symplectic Admin
Date Deposited: 04 Apr 2018 06:22
Last Modified: 19 Jan 2023 06:36
DOI: 10.7554/eLife.32208
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3019756
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