Retinal Changes in Uncomplicated and Severe Plasmodium knowlesi Malaria

G Govindasamy, Bridget Barber, SA Ghani, Timothy William, Matthew Grigg, S Borooah, B Dhillon, Arjen Dondorp, Tsin Yeo, Nicholas Anstey, Richard Maude

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Plasmodium knowlesi causes severe malaria, but its pathogenesis is poorly understood. Retinal changes provide insights into falciparum malaria pathogenesis but have not been studied in knowlesi malaria.

Methods:
An observational study was conducted in Malaysian adults hospitalized with severe (n = 20) and nonsevere (n = 24) knowlesi malaria using indirect ophthalmoscopy (n = 44) and fundus photography (n = 29).

Results: The patients' median age was 44 years (range, 18-74 years). No coma or deaths occurred. Photography detected retinal changes in 11 of 12 patients (92%) with severe and 14 of 17 (82%) with nonsevere knowlesi malaria. Nonspecific retinal whitening occurred in 3 (35%) and 5 (29%) patients with severe and nonsevere disease, respectively; hemorrhages in 2 (17%) and 3 (18%); loss of retinal pigment epithelium in 1 (8%) and 4 (24%); and drusen in 9 (71%) and 12 (75%). All changes were mild, with no significant differences between severe and nonsevere disease. Patients with retinal hemorrhages had lower platelet counts than those without (median, 22 vs 43 × 109/L; P =. 04). 

Conclusions:
The paucity of specific retinal findings associated with disease severity in knowlesi malaria contrasts with the retinopathy of severe adult falciparum malaria with and without coma, suggesting that falciparum-like microvascular sequestration in the brain is not a major component in severe knowlesi malaria pathogenesis.
Original languageEnglish
Pages (from-to)1476-1482
Number of pages7
JournalJournal of Infectious Diseases
Volume213
Issue number9
DOIs
Publication statusPublished - 2016

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Plasmodium knowlesi
Plasmodium malariae
Malaria
Falciparum Malaria
Photography
Coma
Retinal Hemorrhage
Ophthalmoscopy
Retinal Pigment Epithelium
Platelet Count
Observational Studies
Hemorrhage
Brain

Cite this

Govindasamy, G ; Barber, Bridget ; Ghani, SA ; William, Timothy ; Grigg, Matthew ; Borooah, S ; Dhillon, B ; Dondorp, Arjen ; Yeo, Tsin ; Anstey, Nicholas ; Maude, Richard. / Retinal Changes in Uncomplicated and Severe Plasmodium knowlesi Malaria. In: Journal of Infectious Diseases. 2016 ; Vol. 213, No. 9. pp. 1476-1482.
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title = "Retinal Changes in Uncomplicated and Severe Plasmodium knowlesi Malaria",
abstract = "Background: Plasmodium knowlesi causes severe malaria, but its pathogenesis is poorly understood. Retinal changes provide insights into falciparum malaria pathogenesis but have not been studied in knowlesi malaria. Methods: An observational study was conducted in Malaysian adults hospitalized with severe (n = 20) and nonsevere (n = 24) knowlesi malaria using indirect ophthalmoscopy (n = 44) and fundus photography (n = 29).Results: The patients' median age was 44 years (range, 18-74 years). No coma or deaths occurred. Photography detected retinal changes in 11 of 12 patients (92{\%}) with severe and 14 of 17 (82{\%}) with nonsevere knowlesi malaria. Nonspecific retinal whitening occurred in 3 (35{\%}) and 5 (29{\%}) patients with severe and nonsevere disease, respectively; hemorrhages in 2 (17{\%}) and 3 (18{\%}); loss of retinal pigment epithelium in 1 (8{\%}) and 4 (24{\%}); and drusen in 9 (71{\%}) and 12 (75{\%}). All changes were mild, with no significant differences between severe and nonsevere disease. Patients with retinal hemorrhages had lower platelet counts than those without (median, 22 vs 43 × 109/L; P =. 04). Conclusions: The paucity of specific retinal findings associated with disease severity in knowlesi malaria contrasts with the retinopathy of severe adult falciparum malaria with and without coma, suggesting that falciparum-like microvascular sequestration in the brain is not a major component in severe knowlesi malaria pathogenesis.",
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Govindasamy, G, Barber, B, Ghani, SA, William, T, Grigg, M, Borooah, S, Dhillon, B, Dondorp, A, Yeo, T, Anstey, N & Maude, R 2016, 'Retinal Changes in Uncomplicated and Severe Plasmodium knowlesi Malaria', Journal of Infectious Diseases, vol. 213, no. 9, pp. 1476-1482. https://doi.org/10.1093/infdis/jiv746

Retinal Changes in Uncomplicated and Severe Plasmodium knowlesi Malaria. / Govindasamy, G; Barber, Bridget; Ghani, SA; William, Timothy; Grigg, Matthew; Borooah, S; Dhillon, B; Dondorp, Arjen; Yeo, Tsin; Anstey, Nicholas; Maude, Richard.

In: Journal of Infectious Diseases, Vol. 213, No. 9, 2016, p. 1476-1482.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Retinal Changes in Uncomplicated and Severe Plasmodium knowlesi Malaria

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AU - Barber, Bridget

AU - Ghani, SA

AU - William, Timothy

AU - Grigg, Matthew

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AU - Yeo, Tsin

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AU - Maude, Richard

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N2 - Background: Plasmodium knowlesi causes severe malaria, but its pathogenesis is poorly understood. Retinal changes provide insights into falciparum malaria pathogenesis but have not been studied in knowlesi malaria. Methods: An observational study was conducted in Malaysian adults hospitalized with severe (n = 20) and nonsevere (n = 24) knowlesi malaria using indirect ophthalmoscopy (n = 44) and fundus photography (n = 29).Results: The patients' median age was 44 years (range, 18-74 years). No coma or deaths occurred. Photography detected retinal changes in 11 of 12 patients (92%) with severe and 14 of 17 (82%) with nonsevere knowlesi malaria. Nonspecific retinal whitening occurred in 3 (35%) and 5 (29%) patients with severe and nonsevere disease, respectively; hemorrhages in 2 (17%) and 3 (18%); loss of retinal pigment epithelium in 1 (8%) and 4 (24%); and drusen in 9 (71%) and 12 (75%). All changes were mild, with no significant differences between severe and nonsevere disease. Patients with retinal hemorrhages had lower platelet counts than those without (median, 22 vs 43 × 109/L; P =. 04). Conclusions: The paucity of specific retinal findings associated with disease severity in knowlesi malaria contrasts with the retinopathy of severe adult falciparum malaria with and without coma, suggesting that falciparum-like microvascular sequestration in the brain is not a major component in severe knowlesi malaria pathogenesis.

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