Cerebral malaria: insight into pathology from optical coherence tomography

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)...

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Autores principales:	Zhanhan Tu, Jack Gormley, Viral Sheth, Karl B. Seydel, Terrie Taylor, Nicholas Beare, Valentina Barrera, Frank A. Proudlock, Chatonda Manda, Simon Harding, Irene Gottlob
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/d0e171e9f1664dbbba0931106fa0adbd
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spelling	oai:doaj.org-article:d0e171e9f1664dbbba0931106fa0adbd2021-12-02T18:49:25ZCerebral malaria: insight into pathology from optical coherence tomography10.1038/s41598-021-94495-92045-2322https://doaj.org/article/d0e171e9f1664dbbba0931106fa0adbd2021-08-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-94495-9https://doaj.org/toc/2045-2322Abstract 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.Zhanhan TuJack GormleyViral ShethKarl B. SeydelTerrie TaylorNicholas BeareValentina BarreraFrank A. ProudlockChatonda MandaSimon HardingIrene GottlobNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Zhanhan Tu Jack Gormley Viral Sheth Karl B. Seydel Terrie Taylor Nicholas Beare Valentina Barrera Frank A. Proudlock Chatonda Manda Simon Harding Irene Gottlob Cerebral malaria: insight into pathology from optical coherence tomography
description	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.
format	article
author	Zhanhan Tu Jack Gormley Viral Sheth Karl B. Seydel Terrie Taylor Nicholas Beare Valentina Barrera Frank A. Proudlock Chatonda Manda Simon Harding Irene Gottlob
author_facet	Zhanhan Tu Jack Gormley Viral Sheth Karl B. Seydel Terrie Taylor Nicholas Beare Valentina Barrera Frank A. Proudlock Chatonda Manda Simon Harding Irene Gottlob
author_sort	Zhanhan Tu
title	Cerebral malaria: insight into pathology from optical coherence tomography
title_short	Cerebral malaria: insight into pathology from optical coherence tomography
title_full	Cerebral malaria: insight into pathology from optical coherence tomography
title_fullStr	Cerebral malaria: insight into pathology from optical coherence tomography
title_full_unstemmed	Cerebral malaria: insight into pathology from optical coherence tomography
title_sort	cerebral malaria: insight into pathology from optical coherence tomography
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/d0e171e9f1664dbbba0931106fa0adbd
work_keys_str_mv	AT zhanhantu cerebralmalariainsightintopathologyfromopticalcoherencetomography AT jackgormley cerebralmalariainsightintopathologyfromopticalcoherencetomography AT viralsheth cerebralmalariainsightintopathologyfromopticalcoherencetomography AT karlbseydel cerebralmalariainsightintopathologyfromopticalcoherencetomography AT terrietaylor cerebralmalariainsightintopathologyfromopticalcoherencetomography AT nicholasbeare cerebralmalariainsightintopathologyfromopticalcoherencetomography AT valentinabarrera cerebralmalariainsightintopathologyfromopticalcoherencetomography AT frankaproudlock cerebralmalariainsightintopathologyfromopticalcoherencetomography AT chatondamanda cerebralmalariainsightintopathologyfromopticalcoherencetomography AT simonharding cerebralmalariainsightintopathologyfromopticalcoherencetomography AT irenegottlob cerebralmalariainsightintopathologyfromopticalcoherencetomography
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Cerebral malaria: insight into pathology from optical coherence tomography

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