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Goyal MS, Vidal L, Chetcuti K, Chilingulo C, Ibrahim K, Zhang J, Small DS, Seydel KB, O'Brien N, Taylor TE, Postels DG. MRI-Based Brain Volume Scoring in Cerebral Malaria Is Externally Valid and Applicable to Lower-Resolution Images. AJNR Am J Neuroradiol 2024; 45:205-210. [PMID: 38216302 DOI: 10.3174/ajnr.a8098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/06/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND AND PURPOSE Children with cerebral malaria have an elevated risk of mortality and neurologic morbidity. Both mortality and morbidity are associated with initially increased brain volume on MR imaging, as graded by the Brain Volume Score, a subjective ordinal rating scale created specifically for brain MRIs in children with cerebral malaria. For the Brain Volume Score to be more widely clinically useful, we aimed to determine its independent reproducibility and whether it can be applicable to lower-resolution MRIs. MATERIALS AND METHODS To assess the independent reproducibility of the Brain Volume Score, radiologists not associated with the initial study were trained to score MRIs from a new cohort of patients with cerebral malaria. These scores were then compared with survival and neurologic outcomes. To assess the applicability to lower-resolution MRI, we assigned Brain Volume Scores to brain MRIs degraded to simulate a very-low-field (64 mT) portable scanner and compared these with the original scores assigned to the original nondegraded MRIs. RESULTS Brain Volume Scores on the new cohort of patients with cerebral malaria were highly associated with outcomes (OR for mortality = 16, P < .001). Scoring of the simulated degraded images remained consistent with the Brain Volume Scores assigned to the original higher-quality (0.35 T) images (intraclass coefficients > 0.86). CONCLUSIONS Our findings demonstrate that the Brain Volume Score is externally valid in reproducibly predicting outcomes and can be reliably assigned to lower-resolution images.
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Affiliation(s)
- Manu S Goyal
- From the Mallinckrodt Institute of Radiology (M.S.G.), Washington University School of Medicine, St. Louis, Missouri
| | - Lorenna Vidal
- Children's Hospital of Philadelphia (L.V.), Philadelphia, Pennsylvania
| | - Karen Chetcuti
- Department of Radiology (K.C.), Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Radiology (K.C., C.C.), Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Cowles Chilingulo
- Department of Radiology (K.C., C.C.), Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Khalid Ibrahim
- College of Osteopathic Medicine (K.B.S., T.E.T., K.I.), Michigan State University, East Lansing, Michigan
| | - Jeffrey Zhang
- Department of Statistics and Data Science (J.Z., D.S.S.), The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dylan S Small
- Department of Statistics and Data Science (J.Z., D.S.S.), The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karl B Seydel
- College of Osteopathic Medicine (K.B.S., T.E.T., K.I.), Michigan State University, East Lansing, Michigan
- Blantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Nicole O'Brien
- Blantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi
- Nationwide Children's Hospital (N.O.), Division of Pediatric Critical Care, Columbus, Ohio
| | - Terrie E Taylor
- College of Osteopathic Medicine (K.B.S., T.E.T., K.I.), Michigan State University, East Lansing, Michigan
- Blantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Douglas G Postels
- Blantyre Malaria Project, (K.B.S., N.O., T.E.T., D.G.P.) Kamuzu University of Health Sciences, Blantyre, Malawi
- Division of Neurology (D.G.P.), The George Washington University, Children's National Medical Center, Washington, DC
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Olowojesiku R, Sherman MG, Mukadam AM, Imam R, Chastang KM, Seydel KB, Liomba AM, Barber JR, O'Brien NF, Postels DG. Post hospital admission blood lactate measurements are associated with mortality but not neurologic morbidity in children with cerebral malaria. Malar J 2024; 23:28. [PMID: 38243243 PMCID: PMC10797711 DOI: 10.1186/s12936-024-04843-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND In children with cerebral malaria (CM) admission blood lactate has previously guided intravenous fluid therapy and been validated as a prognostic biomarker associated with death. The usefulness of post-admission measurements of blood lactate in children with CM is less clear. The strength of association between blood lactate and neurological sequelae in CM survivors, as well as the optimal duration of post-admission measurements of blood lactate to identify children at higher risk of adverse outcomes is unknown. METHODS A retrospective cohort study of 1674 Malawian children with CM hospitalized from 2000 to 2018 who had blood lactate measurements every 6 h for the first 24 h after admission was performed. The strength of association between admission lactate or values measured at any time point in the first 24 h post-admission and outcomes (mortality and neurological morbidity in survivors) was estimated. The duration of time after admission that lactate remained a valid prognostic biomarker was assessed. RESULTS When lactate is analysed as a continuous variable, children with CM who have higher values at admission have a 1.05-fold higher odds (95% CI 0.99-1.11) of death compared to those with lower lactate values. Children with higher blood lactate at 6 h have 1.16-fold higher odds (95% CI 1.09-1.23) of death, compared to those with lower values. If lactate levels are dichotomized into hyperlactataemic (lactate > 5.0 mmol/L) or not, the strength of association between admission lactate and mortality increases (OR = 2.49, 95% CI 1.47-4.22). Blood lactate levels obtained after 18 h post-admission are not associated with outcomes. Similarly, the change in lactate concentrations through time during the first 24 h of hospital admission is not associated with outcomes. Blood lactate during hospitalization is not associated with adverse neurologic outcomes in CM survivors. CONCLUSIONS In children with CM, blood lactate is associated with death but not neurologic morbidity in survivors. To comprehensively estimate prognosis, blood lactate in children with CM should be assessed at admission and for 18 h afterwards.
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Affiliation(s)
- Ronke Olowojesiku
- Department of Pediatrics, Children's National Hospital, Washington, DC, USA
| | - Meredith G Sherman
- Global Health Initiative, Children's National Hospital, Washington, DC, USA
| | | | - Rami Imam
- The George Washington University School of Medicine, Washington, DC, USA
| | | | - Karl B Seydel
- Michigan State University, East Lansing, MI, USA
- Kamuzu University of Health Sciences, Blantyre Malaria Project, Blantyre, Malawi
| | - Alice M Liomba
- Kamuzu University of Health Sciences, Blantyre Malaria Project, Blantyre, Malawi
| | - John R Barber
- Division of Biostatistics and Study Methodology, Children's National Research Institute, Washington, DC, USA
| | - Nicole F O'Brien
- Kamuzu University of Health Sciences, Blantyre Malaria Project, Blantyre, Malawi
- Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Douglas G Postels
- Kamuzu University of Health Sciences, Blantyre Malaria Project, Blantyre, Malawi.
- Division of Neurology, George Washington University/Children's National Hospital, Washington, DC, USA.
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Varshney RK. State of the Globe: Deciphering the Puzzle of Cerebral Malaria in Children. J Glob Infect Dis 2024; 16:1-2. [PMID: 38680755 PMCID: PMC11045154 DOI: 10.4103/jgid.jgid_50_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Rohit Kumar Varshney
- Department of Emergency Medicine, Kalyan Singh Government Medical College, Bulandshahr, Uttar Pradesh, India
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Pinheiro ADS, Kazura JW, Pinheiro AA, Schmaier AH. Is there a role for bradykinin in cerebral malaria pathogenesis? Front Cell Infect Microbiol 2023; 13:1184896. [PMID: 37637466 PMCID: PMC10448822 DOI: 10.3389/fcimb.2023.1184896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Malaria is a parasitic disease of global health significance and a leading cause of death in children living in endemic regions. Although various Plasmodium species are responsible for the disease, Plasmodium falciparum infection accounts for most severe cases of the disease in humans. The mechanisms of cerebral malaria pathogenesis have been studied extensively in humans and animal malaria models; however, it is far from being fully understood. Recent discoveries indicate a potential role of bradykinin and the kallikrein kinin system in the pathogenesis of cerebral malaria. The aim of this review is to highlight how bradykinin is formed in cerebral malaria and how it may impact cerebral blood-brain barrier function. Areas of interest in this context include Plasmodium parasite enzymes that directly generate bradykinin from plasma protein precursors, cytoadhesion of P. falciparum infected red blood cells to brain endothelial cells, and endothelial cell blood-brain barrier disruption.
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Affiliation(s)
- Alessandro de Sa Pinheiro
- Department of Medicine, Hematology and Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - James W. Kazura
- Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University, Cleveland, OH, United States
| | - Ana Acacia Pinheiro
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Alvin H. Schmaier
- Department of Medicine, Hematology and Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States
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Douglas-Vail M, Fah J, Cotran-Lenrow A, Pintwala RC. Optic Disc Elevation Secondary to Cerebral Malaria Resolves Completely With Mannitol Administration and Corresponds to Clinical Improvement. Cureus 2023; 15:e40639. [PMID: 37476140 PMCID: PMC10355342 DOI: 10.7759/cureus.40639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
This case report describes a 14-year-old boy presenting with cerebral malaria in a resource-limited setting. The patient exhibited optic disc elevation, indicating increased intracranial pressure (ICP). Due to the unavailability of advanced neuroimaging, point-of-care ultrasound (POCUS) was employed to assess the optic disc. After administration of a weight-based dose of mannitol, optic disc elevation resolved completely, accompanied by clinical improvement. This case highlights the potential of POCUS as a valuable tool for the assessment and management of cerebral malaria in resource-limited settings.
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Affiliation(s)
- Matthew Douglas-Vail
- Department of Emergency Medicine, The University of British Columbia, Vancouver, CAN
- Emergency Medicine, Partners In Health Liberia, Harper, LBR
| | - James Fah
- Emergency Medicine, J.J. Dosen Hospital, Ministry of Health, Harper, LBR
| | | | - Robert C Pintwala
- Department of Ophthalmology and Vision Science, The University of British Columbia, Vancouver, CAN
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Lorenzini PA, Gusareva ES, Ghosh AG, Ramli NAB, Preiser PR, Kim HL. Population-specific positive selection on low CR1 expression in malaria-endemic regions. PLoS One 2023; 18:e0280282. [PMID: 36626386 PMCID: PMC9831336 DOI: 10.1371/journal.pone.0280282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/25/2022] [Indexed: 01/11/2023] Open
Abstract
Complement Receptor Type 1 (CR1) is a malaria-associated gene that encodes a transmembrane receptor of erythrocytes and is crucial for malaria parasite invasion. The expression of CR1 contributes to the rosetting of erythrocytes in the brain bloodstream, causing cerebral malaria, the most severe form of the disease. Here, we study the history of adaptation against malaria by analyzing selection signals in the CR1 gene. We used whole-genome sequencing datasets of 907 healthy individuals from malaria-endemic and non-endemic populations. We detected robust positive selection in populations from the hyperendemic regions of East India and Papua New Guinea. Importantly, we identified a new adaptive variant, rs12034598, which is associated with a slower rate of erythrocyte sedimentation and is linked with a variant associated with low levels of CR1 expression. The combination of the variants likely drives natural selection. In addition, we identified a variant rs3886100 under positive selection in West Africans, which is also related to a low level of CR1 expression in the brain. Our study shows the fine-resolution history of positive selection in the CR1 gene and suggests a population-specific history of CR1 adaptation to malaria. Notably, our novel approach using population genomic analyses allows the identification of protective variants that reduce the risk of malaria infection without the need for patient samples or malaria individual medical records. Our findings contribute to understanding of human adaptation against cerebral malaria.
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Affiliation(s)
- Paolo Alberto Lorenzini
- Asian School of the Environment, Nanyang Technological University, Singapore, Singapore
- The GenomeAsia 100K Consortium, Singapore, Singapore
| | - Elena S. Gusareva
- Asian School of the Environment, Nanyang Technological University, Singapore, Singapore
- The GenomeAsia 100K Consortium, Singapore, Singapore
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Amit Gourav Ghosh
- Asian School of the Environment, Nanyang Technological University, Singapore, Singapore
- The GenomeAsia 100K Consortium, Singapore, Singapore
| | - Nurul Adilah Binte Ramli
- Asian School of the Environment, Nanyang Technological University, Singapore, Singapore
- The GenomeAsia 100K Consortium, Singapore, Singapore
| | - Peter Rainer Preiser
- School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Hie Lim Kim
- Asian School of the Environment, Nanyang Technological University, Singapore, Singapore
- The GenomeAsia 100K Consortium, Singapore, Singapore
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
- * E-mail:
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