Cerebral Malaria: Insight into Pathology from Optical Coherence Tomography

Overview

Journal Sci Rep

Specialty Science

Date 2021 Aug 4

PMID 34344903

Citations 12

Authors

Zhanhan Tu

Jack Gormley

Viral Sheth

Karl B Seydel

Terrie Taylor

Nicholas Beare

Valentina Barrera

Frank A Proudlock

Chatonda Manda

Simon Harding

Irene Gottlob

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

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Type II Acute Macular Neuroretinopathy Secondary to Malaria.

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Predicting Acute and Post-Recovery Outcomes in Cerebral Malaria and Other Comas by Optical Coherence Tomography (OCT in CM) - A protocol for an observational cohort study of Malawian children.

Wilson K, Tu Z, Mbale E, Mhango P, Kayange P, Gladstone M Wellcome Open Res. 2023; 8:172.

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Interplay Between the Immune and Nervous Cognitive Systems in Homeostasis and in Malaria.

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Retinal imaging technologies in cerebral malaria: a systematic review.

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