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

Barrera, V, MacCormick, IJC, Czanner, G, Hiscott, PS, White, VA, Craig, AG, Beare, NAV, Culshaw, LH, Zheng, Y, Biddolph, SC, Milner, DA, Kamiza, S, Molyneux, ME, Taylor, TE and Harding, SP (2018) Neurovascular sequestration in paediatric P. falciparum malaria is visible clinically in the retina. eLife, 7. ISSN 2050-084X

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Abstract

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.

Item Type: Article
Uncontrolled Keywords: 0601 Biochemistry and Cell Biology
Subjects: Q Science > QR Microbiology > QR355 Virology
R Medicine > RM Therapeutics. Pharmacology
Divisions: Applied Mathematics
Publisher: eLife Sciences Publications Ltd
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Date Deposited: 07 Oct 2019 11:25
Last Modified: 07 Oct 2019 11:30
DOI or Identification number: 10.7554/eLife.32208
URI: http://researchonline.ljmu.ac.uk/id/eprint/11482

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