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 journalArticle

    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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  • Cite this

    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, 213(9), 1476-1482. https://doi.org/10.1093/infdis/jiv746