Cerebral malaria: insight into pathology from optical coherence tomography.
Cerebral malaria: insight into pathology from optical coherence tomography.
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DOI：
10.1038/s41598-021-94495-9
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发表时间：
2021-08-03
影响因子：
4.6
通讯作者：
Gottlob I
中科院分区：
文献类型：
--
作者：
Tu Z;Gormley J;Sheth V;Seydel KB;Taylor T;Beare N;Barrera V;Proudlock FA;Manda C;Harding S;Gottlob I
我们的目的是调查结构视网膜病变疟疾视网膜病变（MR）使用手持光学相干断层扫描（HH-OCT），以评估其诊断潜力。MR儿童（n = 43）在入院时、出院后1个月（n = 31）和1年（n = 8）接受了眼底镜检查、荧光素血管造影和HH-OCT。对照组为无疟疾的昏迷患者（n = 6）和年龄/性别匹配的健康儿童（n = 43）。比较OCT变化和视网膜层厚度。在HH-OCT上，在81%的MR患者的内层视网膜中观察到高反射区（HRA），对应于眼底照相的缺血性视网膜变白。37%的患者出现棉絮样斑点，93%的患者出现异常高反射斑点，与毛细血管丛共定位。84%的患者存在高反射血管壁，9%存在视网膜内囊肿。血管变化和囊肿在48小时内消退。HRA在1个月时发展为视网膜变薄（p = 0.027），1年后更明显（p = 0.009）。缺血性视网膜变白位于视网膜内层，与棉絮斑不同。血管高反射率可能代表寄生红细胞在血管中的隔离，这是一个关键的CM特征。缺血后视网膜萎缩和脑萎缩伴认知功能障碍的机制在CM幸存者中可能是相似的。HH-OCT具有监测患者、治疗反应和预测神经功能缺损的潜力。
We aimed to investigate structural retinal changes in malarial retinopathy (MR) using hand-held optical coherence tomography (HH-OCT) to assess its diagnostic potential. Children with MR (n = 43) underwent ophthalmoscopy, fluorescein angiography and HH-OCT during admission, 1-month (n = 31) and 1-year (n = 8) post-discharge. Controls were comatose patients without malaria (n = 6) and age/sex-matched healthy children (n = 43). OCT changes and retinal layer thicknesses were compared. On HH-OCT, hyper-reflective areas (HRAs) were seen in the inner retina of 81% of MR patients, corresponding to ischaemic retinal whitening on fundus photography. Cotton wool spots were present in 37% and abnormal hyper-reflective dots, co-localized to capillary plexus, in 93%. Hyper-reflective vessel walls were present in 84%, and intra-retinal cysts in 9%. Vascular changes and cysts resolved within 48 h. HRAs developed into retinal thinning at 1 month (p = 0.027) which was more pronounced after 1 year (p = 0.009). Ischaemic retinal whitening is located within inner retinal layers, distinguishing it from cotton wool spots. Vascular hyper-reflectivity may represent the sequestration of parasitized erythrocytes in vessels, a key CM feature. The mechanisms of post-ischemic retinal atrophy and cerebral atrophy with cognitive impairment may be similar in CM survivors. HH-OCT has the potential for monitoring patients, treatment response and predicting neurological deficits.
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DOI：
10.1056/nejmoa1400116
发表时间：
2015-03-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
Seydel KB;Kampondeni SD;Valim C;Potchen MJ;Milner DA;Muwalo FW;Birbeck GL;Bradley WG;Fox LL;Glover SJ;Hammond CA;Heyderman RS;Chilingulo CA;Molyneux ME;Taylor TE
通讯作者：
Taylor TE
影响因子：
5.2
作者：
Newton, CRJC;Crawley, J;Kirkham, FJ
通讯作者：
Kirkham, FJ
影响因子：
--
作者：
Beare, NA;Southern, C;Harding, SP
通讯作者：
Harding, SP
影响因子：
6.5
作者：
CLEMENS, R;PRAMOOLSINSAP, C;WHITE, NJ
通讯作者：
WHITE, NJ
DOI：
10.4269/ajtmh.1994.51.372
发表时间：
1994-09-01
影响因子：
3.3
作者：
ELHASSAN, IM;HVIID, L;THEANDER, TG
通讯作者：
THEANDER, TG