TY - JOUR
T1 - Severity of Retinopathy Parallels the Degree of Parasite Sequestration in the Eyes and Brains of Malawian Children With Fatal Cerebral Malaria
AU - Barrera, Valentina
AU - Hiscott, Paul Stephenson
AU - Craig, Alister
AU - White, Valerie Ann
AU - Milner, Danny Arnold
AU - Beare, Nicholas Alexander Venton
AU - MacCormick, Ian James Callum
AU - Kamiza, Steve
AU - Taylor, Terrie Ellen
AU - Molyneux, Malcolm Edward
AU - Harding, Simon Peter
PY - 2014/10/28
Y1 - 2014/10/28
N2 - BackgroundMalarial 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.MethodsIn 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.ResultsFive 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).ConclusionsThese 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.
AB - BackgroundMalarial 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.MethodsIn 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.ResultsFive 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).ConclusionsThese 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.
KW - cerebral malaria
KW - clinicopathological correlation
KW - histopathology
KW - malarial retinopathy
KW - microvascular congestion
KW - neurovasculature
KW - parasite sequestration
KW - pediatric coma
KW - Plasmodium falciparum malaria
KW - vascular pathology
U2 - 10.1093/infdis/jiu592
DO - 10.1093/infdis/jiu592
M3 - Article
SN - 0022-1899
VL - 211
SP - 1977
EP - 1986
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 12
ER -
