Barrera, V;
MacCormick, IJC;
Czanner, G;
Hiscott, PS;
White, VA;
Craig, AG;
Beare, NAV;
... Harding, SP; + view all
(2018)
Neurovascular sequestration in paediatric P. Falciparum malaria is visible clinically in the retina.
eLife
, 7
, Article e32208. 10.7554/eLife.32208.
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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.
| Type: | Article |
|---|---|
| Title: | Neurovascular sequestration in paediatric P. Falciparum malaria is visible clinically in the retina |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.7554/eLife.32208 |
| Publisher version: | http://dx.doi.org/10.7554/eLife.32208 |
| Language: | English |
| Additional information: | Copyright Barrera et al. This article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use and redistribution provided that the original author and source are credited. |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10054980 |
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