Retinal Hemorrhage in Plasmodium vivax Malaria

Abstract

Retinal hemorrhage is a frequently observed sign in Plasmodium falciparum infection. In Plasmodium vivax infection, however, retinal hemorrhage is very rare; only five cases have been reported in the literature. In this case report, we review the literature and the case of 52-year-old man who had retinal hemorrhages in P. vivax infection. We analyzed the structural characteristics of the lesions using fluorescein angiography and spectral-domain optical coherence tomography. Physicians should be aware of the possibility of retinal hemorrhage in malaria patients, even those with P. vivax infection, and should consider a diagnosis of malaria in a patient with unexplained retinal hemorrhage and fever.

Retinopathy of vivax malaria in adults and its relation with severity parameters

“…15 Choi et al and Lee et al also reported one case each from South Korea while citing previous two other Korean cases. 16,17 The cases of vivax with retinal hemorrhages reported earlier had variable levels of hemoglobin and platelet counts. All five cases in our series had severe anemia.…”

“…17 The retinal changes tend to be associated with severe manifestations and probably relate to the correlated number of retinal hemorrhages to density of brain hemorrhages in children dying of cerebral malaria. 23 The mechanism of retinal hemorrhage is uncertain in P. vivax infection.…”

“…Only 1 case of vivax malaria has been reported earlier to have cotton wool spot. 17 The cotton wool spot, a disorder in axonal transport, is thought to develop because of the localized ischemia of retina. pathogenesis of severity or its effects.…”

“…[12][13][14] There have been few isolated case reports regarding eye changes in cases of vivax malaria including retinal hemorrhages. [15][16][17][18] The presence of retinal changes assumes the importance in light of increased recognition of severe disease in vivax malaria.…”

Comparative ophthalmic assessment of patients receiving tafenoquine or chloroquine/primaquine in a randomized clinical trial for Plasmodium vivax malaria radical cure

“…Ocular involvement, including retinopathies, is known to occur with P. falciparum malaria in adults and children, and the frequency of retinal changes increases with the severity of the disease [22]. In P. vivax malaria, retinal hemorrhage has been reported but appears to be a rare occurrence; with only six previously published cases [23,24]. In Choi's series, hemorrhage can be either pre-retinal/subhyaloid or retinal and can involve one or both eyes with the recovery period of 1 week to 5 months [24].…”