Retinal Changes in Cerebral Malaria among Sudanese patient in Khartoum State, Sudan 2019

Introduction: It is thought that Malaria parasites live in red blood cells and make them stick to the inside of small blood vessels, particularly in the brain and also the eye. The light-sensitive tissue in the eye is also affected because the parasites disrupt the supply of oxygen and nutrients These changes, known as malarial retinopathy, include white, opaque patches, whitening of the infected blood vessels, bleeding into the retina and swelling of the optic nerve. Objectives: Our study was aimed to demonstrate malarial retinopathy in patients presented with neurological manifestations of malaria. Methodology: A cross-sectional Hospital based study included all patients with malaria seen during the period between 1-1-2019 and 25-4-2019

Retinal Changes in Severe Malaria in Bangladeshi Children

Background: In malaria endemic areas diagnosis of severe malaria by microscopy and immunodiagnostic test is confounded by asymptomatic peripheral blood parasitemia. In such settings, retinal changes by ophthalmoscopy showed some diagnostic utility. Contribution of ophthalmoscopy in diagnosis of severe malaria in children is not well studied in Bangladesh. The aim of this study was to describe the retinal findings in children of cerebral and non-cerebral severe malaria by direct and indirect ophthalmoscope and relate their outcome and to determine the course of changes in the fundus. Methodology: In this prospective observational study 130 consecutive children aged between 6 months to 12 years admitted with confirmed severe Plasmodium falciparum malaria in pediatrics ward of Chittagong Medical College Hospital, Chittagong, Bangladesh were assessed by both direct and indirect ophthalmoscopy during the period of April 2008 to March 2009. Results: Out of 130 patients 80 children had cerebral malaria and of these 49 (61.2%) had some degree of retinopathy; 24 (48%) of 50 with non cerebral severe malaria had retinopathy. Predominant retinal changes were Retinal hemorrhage and Macular whitening each in 53 (40.77%) patients, followed by peripheral whitening, Vessels changes and papilloedema in 50 (38.46%), 40 (30.77%) and 14 (10.78%) patients respectively. With indirect ophthalmoscope as reference, direct ophthalmoscopy had a high sensitivity to detect macular whitening, and papilloedema but was less sensitive to detect peripheral whitening and vessel changes. Patients with retinopathy had more chance to had unfavorable outcome (Death) in comparison to the patients who had not {Odds ratio:1.09 (95% CI:1.017-1.167)}. Most of these retinal changes were transient and resolved gradually as clinical condition improved. Conclusion:Features compatible with malarial retinopathy were commonly found in our children with severe malaria. Ophthalmoscopy is an important clinical tool to aid in diagnosis and prognosis in children. However, indirect ophthalmoscopy provides better information than direct ophthalmoscopy. Bangladesh J Child Health 2018; VOL 42 (3) :118-124

Neurovascular sequestration in paediatric P. falciparum malaria is visible clinically in the retina

Retinal vessel changes and retinal whitening, distinctive features of malarial retinopathy, can be directly observed during routine eye examination in children with P. falciparum cerebral malaria. We investigated their clinical significance and underlying mechanisms through linked clinical, clinicopathological and image analysis studies. Orange vessels and severe foveal whitening (clinical examination, n = 817, OR, 95% CI: 2.90, 1.96–4.30; 3.4, 1.8–6.3, both p<0.001), and arteriolar involvement by intravascular filling defects (angiographic image analysis, n = 260, 2.81, 1.17–6.72, p<0.02) were strongly associated with death. Orange vessels had dense sequestration of late stage parasitised red cells (histopathology, n = 29; sensitivity 0.97, specificity 0.89) involving 360° of the lumen circumference, with altered protein expression in blood-retinal barrier cells and marked loss/disruption of pericytes. Retinal whitening was topographically associated with tissue response to hypoxia. Severe neurovascular sequestration is visible at the bedside, and is a marker of severe disease useful for diagnosis and management.