The spectrum of retinopathy in adults with Plasmodium falciparum malaria.
A specific retinopathy has been described in African children with cerebral malaria, but in adults this has not been extensively studied. Since the structure and function of the retinal vasculature greatly resembles the cerebral vasculature, study of retinal changes can reveal insights into the pathophysiology of cerebral malaria. A detailed observational study of malarial retinopathy in Bangladeshi adults was performed using high-definition portable retinal photography. Retinopathy was present in 17/27 adults (63%) with severe malaria and 14/20 adults (70%) with cerebral malaria. Moderate or severe retinopathy was more frequent in cerebral malaria (11/20, 55%) than in uncomplicated malaria (3/15, 20%; P=0.039), bacterial sepsis (0/5, 0%; P=0.038) or healthy controls (0/18, 0%; P<0.001). The spectrum of malarial retinopathy was similar to that previously described in African children, but no vessel discolouration was observed. The severity of retinal whitening correlated with admission venous plasma lactate (P=0.046), suggesting that retinal ischaemia represents systemic ischaemia. In conclusion, retinal changes related to microvascular obstruction were common in adults with severe falciparum malaria and correlated with disease severity and coma, suggesting that a compromised microcirculation has important pathophysiological significance in severe and cerebral malaria. Portable retinal photography has potential as a valuable tool to study malarial retinopathy.
Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. richardmaude@gmail.com
Richard J
RJ
Maude
Nicholas A V
NA
Beare
Abdullah
A
Abu Sayeed
Christina C
CC
Chang
Prakaykaew
P
Charunwatthana
M Abul
MA
Faiz
Amir
A
Hossain
Emran Bin
EB
Yunus
M Gofranul
MG
Hoque
Mahtab Uddin
MU
Hasan
Nicholas J
NJ
White
Nicholas P J
NP
Day
Arjen M
AM
Dondorp
D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000627:therapeutic use; D001459:Bangladesh; D016022:Case-Control Studies; D003128:Coma / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D016779:Malaria, Cerebral / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010781:Photography; D011446:Prospective Studies; D012160:Retina / Q000473:pathology*; D012164:Retinal Diseases / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D055815:Young Adult
D000962:Antimalarials