A retinal model of cerebral malaria

et al. 2020

Preprint

Purpose We aimed to investigate structural retinal changes in malarial retinopathy (MR) using hand-held optical coherence tomography (HH-OCT) to investigate its diagnostic potential.Methods Children with MR (n=43) underwent ophthalmoscopy, fluorescein angiography and HH-OCT during admission, one month (n=31) and one 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.Results On HH-OCT hyper-reflective areas (HRAs) were seen in the inner retina of 81% of MR patients, corresponding to ischaemic retinal whitening. Cotton wool spots present in 37% and abnormal hyper-reflective dots, co-localized to capillary plexi, in 93%. Hyper-reflective vessel walls were present in 84%, and intra-retinal cysts in 9%. Vascular changes and cysts resolved within 48 hours. HRAs developed into retinal thinning at one month (p=0.027) which was more pronounced after one year (p=0.009).Conclusions 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 potential for monitoring patients, treatment response and predicting neurological deficits.

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Cerebral Malaria: Insight into Pathology from Optical Coherence Tomography

et al. 2020

Preprint

“…A recent investigation of malarial retinopathy used a mouse model of cerebral malaria to compare changes in OCT to fundus imaging with labelled parasites and histology with immunological markers. 27 It localized the parasites in larger vessels by detecting labelled GFP and in three capillaries layers with CF8 staining, con rming OCT hyperre ectivity in vessels with sequestration and supporting our conclusions. The locations and morphology of the hyper-re ectivity is consistent with our ndings localizing the parasites by detecting GFP expression of clusters of plasmodia in big vessels and all three capillary layers with CF8 staining.…”

Section: Discussionsupporting

confidence: 81%

“…The locations and morphology of the hyper-re ectivity is consistent with our ndings localizing the parasites by detecting GFP expression of clusters of plasmodia in big vessels and all three capillary layers with CF8 staining. 27 Vessels with hyper-re ective lumens on OCT likely represent lumens lled with pRBCs, as uninfected RBCs have a low OCT signal. A hypo-re ective center in a hyper-re ective lumen is probably a narrow area of central patency.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Malaria: Insight into Pathology from Optical Coherence Tomography

et al. 2021

Preprint

PurposeWe aimed to investigate structural retinal changes in malarial retinopathy (MR) using hand-held optical coherence tomography (HH-OCT) to investigate its diagnostic potential.MethodsChildren with MR (n=43) underwent ophthalmoscopy, fluorescein angiography and HH-OCT during admission, one month (n=31) and one 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.ResultsOn HH-OCT, hyper-reflective areas (HRAs) were seen in the inner retina of 81% of MR patients, corresponding to ischaemic retinal whiteningon 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 hours. HRAs developed into retinal thinning at one month (p=0.027) whichwas more pronounced after one year (p=0.009).ConclusionsIschaemic 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 potential for monitoring patients, treatment response and predicting neurological deficits.

Section: Discussionmentioning

confidence: 99%

Cerebral malaria: insight into pathology from optical coherence tomography

et al. 2021

Sci Rep

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.