Ultrasound findings in Plasmodium falciparum malaria: a pilot study.
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.
Murphy
Sarah
S
Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. samurphy@partners.org
Cserti-Gazdewich
Christine
C
Dhabangi
Aggrey
A
Musoke
Charles
C
Nabukeera-Barungi
Nicolette
N
Price
Daniel
D
King
Mary Etta
ME
Romero
Javier
J
Noviski
Natan
N
Dzik
Walter
W
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