Prognostic Significance and Course of Retinopathy in Children WithSevere Malaria

Beare, Nicholas A. V.

doi:10.1001/archopht.122.8.1141

Cited by 149 publications

(181 citation statements)

References 23 publications

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“…Children were eligible for the cerebral malaria group if they met the following inclusion criteria: an age of 0.5-12 years; a Blantyre coma score (BCS) of ≤2 on admission; detection of P. falciparum on a blood smear; no evidence of meningitis; no improvement in the BCS after correction of hypoglycemia (if present); and fundoscopy-based detection of retinopathy (defined as whitening, hemorrhage, or vessel changes) by a trained clinician within 6 hours of admission [13]. Exclusion criteria included gross signs of malnutrition, head trauma, preexisting brain injury, clinical manifestations of advanced AIDS or human immunodeficiency virus infection, or achievement of a BCS of >2 within 4 hours of admission.…”

Section: Human Participation Ethics Statementmentioning

confidence: 99%

Decreased Rate of Plasma Arginine Appearance in Murine Malaria May Explain Hypoargininemia in Children With Cerebral Malaria

et al. 2016

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Background. Plasmodium infection depletes arginine, the substrate for nitric oxide synthesis, and impairs endotheliumdependent vasodilation. Increased conversion of arginine to ornithine by parasites or host arginase is a proposed mechanism of arginine depletion.Methods. We used high-performance liquid chromatography to measure plasma arginine, ornithine, and citrulline levels in Malawian children with cerebral malaria and in mice infected with Plasmodium berghei ANKA with or without the arginase gene. Heavy isotope-labeled tracers measured by quadrupole time-of-flight liquid chromatography-mass spectrometry were used to quantify the in vivo rate of appearance and interconversion of plasma arginine, ornithine, and citrulline in infected mice.Results. Children with cerebral malaria and P. berghei-infected mice demonstrated depletion of plasma arginine, ornithine, and citrulline. Knock out of Plasmodium arginase did not alter arginine depletion in infected mice. Metabolic tracer analysis demonstrated that plasma arginase flux was unchanged by P. berghei infection. Instead, infected mice exhibited decreased rates of plasma arginine, ornithine, and citrulline appearance and decreased conversion of plasma citrulline to arginine. Notably, plasma arginine use by nitric oxide synthase was decreased in infected mice.Conclusions. Simultaneous arginine and ornithine depletion in malaria parasite-infected children cannot be fully explained by plasma arginase activity. Our mouse model studies suggest that plasma arginine depletion is driven primarily by a decreased rate of appearance.

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Section: Human Participation Ethics Statementmentioning

confidence: 99%

Decreased Rate of Plasma Arginine Appearance in Murine Malaria May Explain Hypoargininemia in Children With Cerebral Malaria

et al. 2016

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“…Almost all children with CM who have lumbar puncture have elevated cerebrospinal fluid (CSF) opening pressure 1,2 but only 10-15% have papilledema. 3,4 ICP monitoring in 23 Kenyan children with CM found that all had raised ICP 5 and that single lumbar puncture pressure measurements did not predict the maximum ICP. Several children in that study developed severe intracranial hypertension, all of whom subsequently died or had neurological sequelae.…”

Section: Introductionmentioning

confidence: 98%

Prevalence of Raised Intracranial Pressure in Cerebral Malaria Detected by Optic Nerve Sheath Ultrasound

Beare¹,

Glover²,

Lewallen³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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Abstract. We aimed to use optic nerve sheath (ONS) ultrasound to determine the prevalence of raised intracranial pressure (ICP) in African children with cerebral malaria (CM); and if increased ONS diameter is associated with poor outcome. We measured ONS diameter in 101 children with CM and 11 children with malaria and impaired consciousness in Malawi. The prevalence of raised ICP detected by increased ONS diameter was 49%. Case fatality was similar in children with increased ONS diameter on admission (9/55) and those children without increased ONS diameter (11/57). Neurological sequelae were more common in those children with increased ONS diameter (7/46 versus 2/46, P 0.05). Lumbar puncture (LP) opening pressure was elevated in 95% of 46 children who underwent LP. In Malawian children with CM, raised ICP is less commonly detected by ONS ultrasound than LP. This study suggests that raised ICP is not universal in CM and that other mechanisms may account for coma.

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“…Retinal hemorrhages in these patients usually absorbed spontaneously over the period of one to four weeks without retinal sequelae [9] and visual defect improved completely after successful treatment of malaria. Few cases have been reported with irreversible visual defects [7].…”

Section: Discussionmentioning

confidence: 91%

“…Among these four changes, retinal whitening and vessel changes are specific and diagnostic of severe malarial disease [8]. The incidence of retinal haemorrhages was found in 46% cases of cerebral malaria [9]. This incidence was around 60% in children with cerebral malaria and was lower in less severe malarial disease [2].…”

Section: Discussionmentioning

confidence: 99%

Retinal Hemorrhages in Severe Non-cerebral Plasmodium vivax Malaria in an Adult

Lakhotia

Jagdish²,

Pahadiya³

et al. 2015

JCDR

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A 30-year-male admitted with seven days history of intermittent fever with chills. He had history of Plasmodium vivax malaria two months back and incompletely treated with chloroquine. Patient was not suffering from any chronic illness and had no addiction. He had no history of seizures or altered sensorium. On examination his temperature was 38.5ºC by axilla. The blood pressure was 120/80 mmHg, pulse rate 110 beats/min, regular and respiratory rate was 18 breaths/min. He had severe pallor, icterus, conjuctival hemorrhage and splenomegaly. Signs of meningeal irritation were absent. Cardiovascular and respiratory system revealed no significant abnormality.Two days after admission in the hospital he had history of sudden painless decrease in the vision from both eyes. His visual acuity in left eye was 6/9 and 9/12 in right eye. External ocular muscle movements were normal. Both pupils were round, equal, regular and reacting to direct and consensual light stimulus. Fundus examination revealed multiple retinal hemorrhages with white center and roth spots in all quadrants of fundus of both eyes. Retinal vessels were found tortuous. Papilledema, retinal whitening and exudates were absent [ ABSTRACTMalaria is the most important parasitic diseases of humans and one of the leading causes of morbidity and mortality in tropical countries.Earlier Plasmodium vivax was considered as a benign infection, but now it is recognized as a cause of severe malarial disease. It causes severe malarial disease similar to those as Plasmodium falciparum including cerebral malaria, severe anaemia, severe thrombocytopenia, hepatic dysfunction, shock, acute respiratory distress syndrome (ARDS), acute renal failure, and pulmonary oedema. Malarial retinopathy includes retinal whitening, vessel changes, retinal hemorrhages and papilledema. However, retinal hemorrhages are very rare in Plasmodium vivax infestation. Hereby, we report a case of 30-year-old man, who presented with fever with chills and diminution of vision. He was found to have Plasmodium vivax infection with retinal hemorrhages. He was treated successfully with artisunate, primaquine and doxycycline, completely recovered after one month.keywords: Adult, Non-cerebral malaria, Retinopathy vivax and negative for Plasmodium falciparum. Confirmation of Plasmodium vivax and exclusion of Plasmodium falciparum was done by PCR. NS1 antigen and IgM antibodies were negative for dengue virus. The Chest X-ray and ECG were normal. Ultrasonography of abdomen showed mild hepatosplenomegaly. CT scan of head was done which had no significant abnormality. CSF examination and coagulation profile was normal. Urinanalysis was normal and blood culture was sterile. He was tested negative for HBsAg, Anti-HCV and HIV 1&2. In a case of Plasmodium vivax malaria these finding were suggestive of severe vivax disease. He treated with 120 mg Artisunate iv injections at 0, 12 and 24 h and then OD for seven days with 100 mg doxycycline orally for seven days. Two units of packed cell were transfused. After seven da...

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Prognostic Significance and Course of Retinopathy in Children WithSevere Malaria

Cited by 149 publications

References 23 publications

Decreased Rate of Plasma Arginine Appearance in Murine Malaria May Explain Hypoargininemia in Children With Cerebral Malaria

Decreased Rate of Plasma Arginine Appearance in Murine Malaria May Explain Hypoargininemia in Children With Cerebral Malaria

Prevalence of Raised Intracranial Pressure in Cerebral Malaria Detected by Optic Nerve Sheath Ultrasound

Retinal Hemorrhages in Severe Non-cerebral Plasmodium vivax Malaria in an Adult

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