Retinal pathology of pediatric cerebral malaria in Malawi.
The causes of coma and death in cerebral malaria remain unknown. Malarial retinopathy has been identified as an important clinical sign in the diagnosis and prognosis of cerebral malaria. As part of a larger autopsy study to determine causes of death in children with coma presenting to hospital in B...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2009-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC2627904?pdf=render |
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| author | Valerie A White Susan Lewallen Nicholas A V Beare Malcolm E Molyneux Terrie E Taylor |
| author_facet | Valerie A White Susan Lewallen Nicholas A V Beare Malcolm E Molyneux Terrie E Taylor |
| author_sort | Valerie A White |
| collection | DOAJ |
| description | The causes of coma and death in cerebral malaria remain unknown. Malarial retinopathy has been identified as an important clinical sign in the diagnosis and prognosis of cerebral malaria. As part of a larger autopsy study to determine causes of death in children with coma presenting to hospital in Blantyre, Malawi, who were fully evaluated clinically prior to death, we examined the histopathology of eyes of patients who died and underwent autopsy.Children with coma were admitted to the pediatric research ward, classified according to clinical definitions as having cerebral malaria or another cause of coma, evaluated and treated. The eyes were examined by direct and indirect ophthalmoscopy. If a child died and permission was given, a standardized autopsy was carried out. The patient was then assigned an actual cause of death according to the autopsy findings. The eyes were examined pathologically for hemorrhages, cystoid macular edema, parasite sequestration and thrombi. They were stained immunohistochemically for fibrin and CD61 to identify the components of thrombi, beta-amyloid precursor protein to detect axonal damage, for fibrinogen to identify vascular leakage and for glial fibrillary acidic protein to detect gliosis. Sixty-four eyes from 64 patients were examined: 35 with cerebral malaria and 29 with comas of other causes. Cerebral malaria was distinguished by sequestration of parasitized erythrocytes, the presence and severity of retinal hemorrhages, the presence of cystoid macular edema, the occurrence and number of fibrin-platelet thrombi, the presence and amount of axonal damage and vascular leakage.We found significant differences in retinal histopathology between patients who died of cerebral malaria and those with other diagnoses. These histopathological findings offer insights into the etiology of malarial retinopathy and provide a pathological basis for recently described retinal capillary non-perfusion in children with malarial retinopathy. Because of the similarities between the retina and the brain it also suggests mechanisms that may contribute to coma and death in cerebral malaria. |
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| format | Article |
| id | doaj.art-99a96ddd9124405ab4851b4940f35a8f |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-13T22:56:49Z |
| publishDate | 2009-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-99a96ddd9124405ab4851b4940f35a8f2022-12-22T02:25:58ZengPublic Library of Science (PLoS)PLoS ONE1932-62032009-01-0141e431710.1371/journal.pone.0004317Retinal pathology of pediatric cerebral malaria in Malawi.Valerie A WhiteSusan LewallenNicholas A V BeareMalcolm E MolyneuxTerrie E TaylorThe causes of coma and death in cerebral malaria remain unknown. Malarial retinopathy has been identified as an important clinical sign in the diagnosis and prognosis of cerebral malaria. As part of a larger autopsy study to determine causes of death in children with coma presenting to hospital in Blantyre, Malawi, who were fully evaluated clinically prior to death, we examined the histopathology of eyes of patients who died and underwent autopsy.Children with coma were admitted to the pediatric research ward, classified according to clinical definitions as having cerebral malaria or another cause of coma, evaluated and treated. The eyes were examined by direct and indirect ophthalmoscopy. If a child died and permission was given, a standardized autopsy was carried out. The patient was then assigned an actual cause of death according to the autopsy findings. The eyes were examined pathologically for hemorrhages, cystoid macular edema, parasite sequestration and thrombi. They were stained immunohistochemically for fibrin and CD61 to identify the components of thrombi, beta-amyloid precursor protein to detect axonal damage, for fibrinogen to identify vascular leakage and for glial fibrillary acidic protein to detect gliosis. Sixty-four eyes from 64 patients were examined: 35 with cerebral malaria and 29 with comas of other causes. Cerebral malaria was distinguished by sequestration of parasitized erythrocytes, the presence and severity of retinal hemorrhages, the presence of cystoid macular edema, the occurrence and number of fibrin-platelet thrombi, the presence and amount of axonal damage and vascular leakage.We found significant differences in retinal histopathology between patients who died of cerebral malaria and those with other diagnoses. These histopathological findings offer insights into the etiology of malarial retinopathy and provide a pathological basis for recently described retinal capillary non-perfusion in children with malarial retinopathy. Because of the similarities between the retina and the brain it also suggests mechanisms that may contribute to coma and death in cerebral malaria.http://europepmc.org/articles/PMC2627904?pdf=render |
| spellingShingle | Valerie A White Susan Lewallen Nicholas A V Beare Malcolm E Molyneux Terrie E Taylor Retinal pathology of pediatric cerebral malaria in Malawi. PLoS ONE |
| title | Retinal pathology of pediatric cerebral malaria in Malawi. |
| title_full | Retinal pathology of pediatric cerebral malaria in Malawi. |
| title_fullStr | Retinal pathology of pediatric cerebral malaria in Malawi. |
| title_full_unstemmed | Retinal pathology of pediatric cerebral malaria in Malawi. |
| title_short | Retinal pathology of pediatric cerebral malaria in Malawi. |
| title_sort | retinal pathology of pediatric cerebral malaria in malawi |
| url | http://europepmc.org/articles/PMC2627904?pdf=render |
| work_keys_str_mv | AT valerieawhite retinalpathologyofpediatriccerebralmalariainmalawi AT susanlewallen retinalpathologyofpediatriccerebralmalariainmalawi AT nicholasavbeare retinalpathologyofpediatriccerebralmalariainmalawi AT malcolmemolyneux retinalpathologyofpediatriccerebralmalariainmalawi AT terrieetaylor retinalpathologyofpediatriccerebralmalariainmalawi |