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Cerebral malaria: insight into pathology from optical coherence tomography
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Journal Article
Cerebral malaria: insight into pathology from optical coherence tomography
2021
Overview
We aimed to investigate structural retinal changes in malarial retinopathy (MR) using hand-held optical coherence tomography (HH-OCT) to assess its diagnostic potential. Children with MR (n = 43) underwent ophthalmoscopy, fluorescein angiography and HH-OCT during admission, 1-month (n = 31) and 1-year (n = 8) post-discharge. Controls were comatose patients without malaria (n = 6) and age/sex-matched healthy children (n = 43). OCT changes and retinal layer thicknesses were compared. On HH-OCT, hyper-reflective areas (HRAs) were seen in the inner retina of 81% of MR patients, corresponding to ischaemic retinal whitening on fundus photography. Cotton wool spots were present in 37% and abnormal hyper-reflective dots, co-localized to capillary plexus, in 93%. Hyper-reflective vessel walls were present in 84%, and intra-retinal cysts in 9%. Vascular changes and cysts resolved within 48 h. HRAs developed into retinal thinning at 1 month (
p
= 0.027) which was more pronounced after 1 year (
p
= 0.009). Ischaemic retinal whitening is located within inner retinal layers, distinguishing it from cotton wool spots. Vascular hyper-reflectivity may represent the sequestration of parasitized erythrocytes in vessels, a key CM feature. The mechanisms of post-ischemic retinal atrophy and cerebral atrophy with cognitive impairment may be similar in CM survivors. HH-OCT has the potential for monitoring patients, treatment response and predicting neurological deficits.
Publisher
Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
Subject
/ Atrophy
/ Child
/ Children
/ Coma
/ Cysts
/ Diagnostic Techniques, Ophthalmological
/ Female
/ Humanities and Social Sciences
/ Humans
/ Infant
/ Ischemia
/ Malaria
/ Malaria, Cerebral - diagnosis
/ Malaria, Cerebral - pathology
/ Malaria, Falciparum - diagnosis
/ Malaria, Falciparum - pathology
/ Male
/ Patients
/ Retina
/ Retinal Diseases - diagnosis
/ Retinal Diseases - pathology
/ Science
/ Tomography, Optical Coherence - methods
/ Wool
