title: Ultrasound findings in Plasmodium falciparum malaria: a pilot study.
abstract: OBJECTIVE
  To investigate whether hand-carried ultrasound technology may be valuable in the assessment of children with acute malaria. Every year, approximately 800,000 children under the age of 5 yrs die of complications of Plasmodium falciparum malaria infection. The advent of hand-carried ultrasound technology has made diagnostic ultrasonography possible in underresourced settings.
  
  
  METHODS
  We performed a pilot observational study collecting clinical data and performing ultrasound examinations on children diagnosed with P. falciparum malaria infection. The targeted ultrasound examination included measurement of optic nerve sheath diameter, color transcranial Doppler insonation of the cerebral vasculature, cardiac ultrasound, and abdominal ultrasound.
  
  
  METHODS
  Pediatric acute care unit of Mulago Hospital in Kampala, Uganda.
  
  
  METHODS
  Thirty-three hospitalized children between the ages of 6 months and 12 yrs with documented acute P. falciparum infection.
  
  
  METHODS
  Targeted bedside ultrasound examination.
  
  
  RESULTS
  Increased optic nerve sheath diameter was observed in one third of all patients with malaria and in 100% of the patients diagnosed with cerebral malaria. Although higher-than-normal cerebral blood flow velocities were demonstrated in three (25%) of 12 patients with severe anemia, most patients demonstrated a normal cerebral blood flow velocity, suggesting a blunted response to anemia. We did not find evidence of pulmonary hypertension by cardiac ultrasound, and cardiac function did not seem depressed, even among patients with severe anemia and lactic acidosis. Finally, spleen size as determined by palpation significantly overestimated the true incidence of splenomegaly as measured by ultrasound (48% and 24%, respectively).
  
  
  CONCLUSIONS
  A targeted ultrasound examination focusing on optic nerve sheath diameter, color transcranial Doppler, cardiac ultrasound, and spleen size may prove useful for patient classification, risk stratification, research studies, and treatment monitoring in pediatric malaria. More studies should be done.
authors.affiliation: Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. samurphy@partners.org
authors.forename: Sarah
authors.initials: S
authors.lastname: Murphy
authors.forename: Christine
authors.initials: C
authors.lastname: Cserti-Gazdewich
authors.forename: Aggrey
authors.initials: A
authors.lastname: Dhabangi
authors.forename: Charles
authors.initials: C
authors.lastname: Musoke
authors.forename: Nicolette
authors.initials: N
authors.lastname: Nabukeera-Barungi
authors.forename: Daniel
authors.initials: D
authors.lastname: Price
authors.forename: Mary Etta
authors.initials: ME
authors.lastname: King
authors.forename: Javier
authors.initials: J
authors.lastname: Romero
authors.forename: Natan
authors.initials: N
authors.lastname: Noviski
authors.forename: Walter
authors.initials: W
authors.lastname: Dzik
mesh_terms: D002648:Child; D002675:Child, Preschool; D018618:Echocardiography, Doppler, Color; D005260:Female; D006321:Heart; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D009900:Optic Nerve / Q000000981:diagnostic imaging; D010865:Pilot Projects; D010963:Plasmodium falciparum / Q000302:isolation & purification*; D019095:Point-of-Care Systems; D013154:Spleen / Q000000981:diagnostic imaging; D014454:Uganda; D018615:Ultrasonography, Doppler, Color / Q000295:instrumentation / Q000379:methods; D017585:Ultrasonography, Doppler, Transcranial