Severity of retinopathy parallels the degree of parasite sequestration in the eyes and brains of malawian children with fatal cerebral malaria.
Bottom Line: 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).In addition to being a valuable tool for clinical diagnosis, retinal observations give important information about neurovascular pathophysiology in pediatric CM.
Affiliation: Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool.Show MeSH
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Mentions: In moderate/severe MR cases, pigmented pRBCs were the most predominant forms, with unpigmented pRBCs composing <10% of the total amount of pRBCs sequestered, except patient 5 (Figure 6A). Unpigmented pRBCs were more commonly observed in retinopathy-negative and mild MR cases (Figure 6B and 6C). We used hemozoin as an additional marker of parasite maturation across classification groups (Figure 6D–E). In patients with no MR and those with mild MR, extraerythrocytic hemozoin was seen in <2% of retinal capillaries and <15% of retinal venules. Mean percentages (±SD) of retinal capillaries and venules containing extraerythrocytic hemozoin were high in the moderate/severe MR group (43% ± 24% and 59% ± 28%, respectively). The percentage of retinal capillaries with extraerythrocytic hemozoin was significantly greater in patients with cerebral sequestration plus additional vascular pathology in the brain (CM2) than in patients with cerebral sequestration alone (CM1; P < .05; Figure 6F), confirming previously published evidence for hemozoin in cerebral capillaries .Figure 6.
Affiliation: Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool.