Limits...
Reversibility of retinal microvascular changes in severe falciparum malaria.

Maude RJ, Kingston HW, Joshi S, Mohanty S, Mishra SK, White NJ, Dondorp AM - Am. J. Trop. Med. Hyg. (2014)

Bottom Line: Malarial retinopathy allows detailed study of central nervous system vascular pathology in living patients with severe malaria.An adult with cerebral malaria is described who had prominent retinal whitening with corresponding retinal microvascular obstruction, vessel dilatation, increased vascular tortuosity, and blood retinal barrier leakage with decreased visual acuity, all of which resolved on recovery.Additional study of these features and their potential role in elucidating the pathogenesis of cerebral malaria is warranted.

View Article: PubMed Central - PubMed

Affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Rajthevee, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom; Global Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, Northern Territory, Australia; Ispat General Hospital, Rourkela, Orissa, India richardmaude@gmail.com.

Show MeSH

Related in: MedlinePlus

(A and B) Retinal photographs and (C and D, arterial phase; E and F, late phase) fluorescein angiograms of the left eye. On day 3, increased vessel thickness and tortuosity plus (A) patchy macular whitening with corresponding areas of (C) reduced perfusion and (E) fluorescein leakage were seen. On day 55, normal vessels, (B) no whitening, and (D) normal perfusion around the fovea with (F) no leakage of fluorescein were seen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4155549&req=5

Figure 1: (A and B) Retinal photographs and (C and D, arterial phase; E and F, late phase) fluorescein angiograms of the left eye. On day 3, increased vessel thickness and tortuosity plus (A) patchy macular whitening with corresponding areas of (C) reduced perfusion and (E) fluorescein leakage were seen. On day 55, normal vessels, (B) no whitening, and (D) normal perfusion around the fovea with (F) no leakage of fluorescein were seen.

Mentions: A 24-year-old male truck driver from Orissa, India was admitted with severe Plasmodium falciparum malaria (parasitemia = 0.3%) with coma, generalized convulsions, hyperlactatemia, renal failure, and black urine. He had no prior medical history. Retinal photography showed bilateral patchy macular whitening with corresponding capillary non-perfusion and leakage of fluorescein caused by blood retinal barrier breakdown on fluorescein angiography (Figure 1). He was treated with intravenous artesunate, and from recovery of consciousness on day 3 to discharge, his visual acuity was markedly reduced (counting digits only), with loss of red–green color vision. Repeat examination on day 55 showed that the retinal changes, angiogram abnormalities, and visual deficits had resolved (acuity 6/9 bilaterally and normal color vision). Blood vessel tortuosity measured in three arteries and three veins by a single blinded observer tracing the center line of vessels between branch points in matched pairs of retinal photographs using Adobe Photoshop CS4 (Adobe Systems, San Jose, CA)1 was greater on day 0 than day 55 (mean ratios of vessel widths measured at 10 points in each vessel; 1.226 in arteries and 1.172 in veins; vessel lengths were 1.043 and 1.035). These differences are similar to those found previously in diabetic macular edema.1


Reversibility of retinal microvascular changes in severe falciparum malaria.

Maude RJ, Kingston HW, Joshi S, Mohanty S, Mishra SK, White NJ, Dondorp AM - Am. J. Trop. Med. Hyg. (2014)

(A and B) Retinal photographs and (C and D, arterial phase; E and F, late phase) fluorescein angiograms of the left eye. On day 3, increased vessel thickness and tortuosity plus (A) patchy macular whitening with corresponding areas of (C) reduced perfusion and (E) fluorescein leakage were seen. On day 55, normal vessels, (B) no whitening, and (D) normal perfusion around the fovea with (F) no leakage of fluorescein were seen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4155549&req=5

Figure 1: (A and B) Retinal photographs and (C and D, arterial phase; E and F, late phase) fluorescein angiograms of the left eye. On day 3, increased vessel thickness and tortuosity plus (A) patchy macular whitening with corresponding areas of (C) reduced perfusion and (E) fluorescein leakage were seen. On day 55, normal vessels, (B) no whitening, and (D) normal perfusion around the fovea with (F) no leakage of fluorescein were seen.
Mentions: A 24-year-old male truck driver from Orissa, India was admitted with severe Plasmodium falciparum malaria (parasitemia = 0.3%) with coma, generalized convulsions, hyperlactatemia, renal failure, and black urine. He had no prior medical history. Retinal photography showed bilateral patchy macular whitening with corresponding capillary non-perfusion and leakage of fluorescein caused by blood retinal barrier breakdown on fluorescein angiography (Figure 1). He was treated with intravenous artesunate, and from recovery of consciousness on day 3 to discharge, his visual acuity was markedly reduced (counting digits only), with loss of red–green color vision. Repeat examination on day 55 showed that the retinal changes, angiogram abnormalities, and visual deficits had resolved (acuity 6/9 bilaterally and normal color vision). Blood vessel tortuosity measured in three arteries and three veins by a single blinded observer tracing the center line of vessels between branch points in matched pairs of retinal photographs using Adobe Photoshop CS4 (Adobe Systems, San Jose, CA)1 was greater on day 0 than day 55 (mean ratios of vessel widths measured at 10 points in each vessel; 1.226 in arteries and 1.172 in veins; vessel lengths were 1.043 and 1.035). These differences are similar to those found previously in diabetic macular edema.1

Bottom Line: Malarial retinopathy allows detailed study of central nervous system vascular pathology in living patients with severe malaria.An adult with cerebral malaria is described who had prominent retinal whitening with corresponding retinal microvascular obstruction, vessel dilatation, increased vascular tortuosity, and blood retinal barrier leakage with decreased visual acuity, all of which resolved on recovery.Additional study of these features and their potential role in elucidating the pathogenesis of cerebral malaria is warranted.

View Article: PubMed Central - PubMed

Affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Rajthevee, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom; Global Health Division, Menzies School of Health Research and Charles Darwin University, Casuarina, Northern Territory, Australia; Ispat General Hospital, Rourkela, Orissa, India richardmaude@gmail.com.

Show MeSH
Related in: MedlinePlus