The spectrum of retinopathy in adults with Plasmodium falciparum malaria.
The spectrum of retinopathy in adults with Plasmodium falciparum malaria.
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DOI：
10.1016/j.trstmh.2009.03.001
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发表时间：
2009-07
影响因子：
2.2
通讯作者：
Dondorp AM
中科院分区：
文献类型：
--
作者：
Maude RJ;Beare NA;Abu Sayeed A;Chang CC;Charunwatthana P;Faiz MA;Hossain A;Yunus EB;Hoque MG;Hasan MU;White NJ;Day NP;Dondorp AM
在患有脑型疟疾的非洲儿童中有一种特殊的视网膜病变，但在成人中尚未进行广泛的研究。由于视网膜脉管系统的结构和功能与脑血管系统非常相似，对视网膜变化的研究可以揭示脑疟疾的病理生理学。使用高清晰度便携式视网膜摄影技术对孟加拉国成人疟疾视网膜病变进行了详细的观察研究。重度疟疾患者中有17/27（63%）存在视网膜病变，脑型疟疾患者中有14/20（70%）存在视网膜病变。中度或重度视网膜病变在脑型疟疾（11/ 20,55%）中比在无并发症疟疾（3/ 15,20%;P = 0.039）、细菌性败血症（0/ 5.0%;P = 0.038）或健康对照（0/ 18.0%;P < 0.001）中更为常见。疟疾视网膜病变的频谱与先前在非洲儿童中描述的相似，但未观察到血管变色。视网膜白的严重程度与入院静脉血浆乳酸浓度相关（P = 0.046），提示视网膜缺血代表全身性缺血。综上所述，与微血管阻塞相关的视网膜改变在重症恶性疟疾成人中很常见，并与疾病严重程度和昏迷相关，提示微循环受损在重症和脑型疟疾中具有重要的病理生理意义。便携式视网膜摄影有潜力成为研究疟疾视网膜病变的一种有价值的工具。
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.
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影响因子：
3.7
作者：
White VA;Lewallen S;Beare NA;Molyneux ME;Taylor TE
通讯作者：
Taylor TE
DOI：
10.1016/s0035-9203(99)90071-8
发表时间：
1999-11-01
影响因子：
2.2
作者：
Lewallen, S;Harding, SP;Taylor, TE
通讯作者：
Taylor, TE
影响因子：
--
作者：
Beare, NA;Southern, C;Harding, SP
通讯作者：
Harding, SP
影响因子：
168.9
作者：
Lopez, Alan D.;Mathers, Colin D.;Murray, Christopher J. L.
通讯作者：
Murray, Christopher J. L.
影响因子：
8.8
作者：
Levy, MM;Fink, MP;Ramsay, G
通讯作者：
Ramsay, G