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Sahu PK, Hoffmann A, Majhi M, Pattnaik R, Patterson C, Mahanta KC, Mohanty AK, Mohanty RR, Joshi S, Mohanty A, Bage J, Maharana S, Seitz A, Bendszus M, Sullivan SA, Turnbull IW, Dondorp AM, Gupta H, Pirpamer L, Mohanty S, Wassmer SC. Brain Magnetic Resonance Imaging Reveals Different Courses of Disease in Pediatric and Adult Cerebral Malaria. Clin Infect Dis 2021; 73:e2387-e2396. [PMID: 33321516 PMCID: PMC8492227 DOI: 10.1093/cid/ciaa1647] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cerebral malaria is a common presentation of severe Plasmodium falciparum infection and remains an important cause of death in the tropics. Key aspects of its pathogenesis are still incompletely understood, but severe brain swelling identified by magnetic resonance imaging (MRI) was associated with a fatal outcome in African children. In contrast, neuroimaging investigations failed to identify cerebral features associated with fatality in Asian adults. METHODS Quantitative MRI with brain volume assessment and apparent diffusion coefficient (ADC) histogram analyses were performed for the first time in 65 patients with cerebral malaria to compare disease signatures between children and adults from the same cohort, as well as between fatal and nonfatal cases. RESULTS We found an age-dependent decrease in brain swelling during acute cerebral malaria, and brain volumes did not differ between fatal and nonfatal cases across both age groups. In nonfatal disease, reversible, hypoxia-induced cytotoxic edema occurred predominantly in the white matter in children, and in the basal ganglia in adults. In fatal cases, quantitative ADC histogram analyses also demonstrated different end-stage patterns between adults and children: Severe hypoxia, evidenced by global ADC decrease and elevated plasma levels of lipocalin-2 and microRNA-150, was associated with a fatal outcome in adults. In fatal pediatric disease, our results corroborate an increase in brain volume, leading to augmented cerebral pressure, brainstem herniation, and death. CONCLUSIONS Our findings suggest distinct pathogenic patterns in pediatric and adult cerebral malaria with a stronger cytotoxic component in adults, supporting the development of age-specific adjunct therapies.
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Affiliation(s)
- Praveen K Sahu
- Center for the Study of Complex Malaria in India, Ispat General Hospital, Rourkela, Odisha, India
| | - Angelika Hoffmann
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
- University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Megharay Majhi
- Department of Radiology, Ispat General Hospital, Rourkela, Odisha, India
| | | | - Catriona Patterson
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kishore C Mahanta
- Department of Radiology, Ispat General Hospital, Rourkela, Odisha, India
| | - Akshaya K Mohanty
- Infectious Diseases Biology Unit, Institute of Life Sciences, Bhubaneswar, Odisha, India
| | - Rashmi R Mohanty
- Department of Ophthalmology, Ispat General Hospital, Rourkela, Odisha, India
| | - Sonia Joshi
- Department of Ophthalmology, Ispat General Hospital, Rourkela, Odisha, India
| | - Anita Mohanty
- Department of Intensive Care, Ispat General Hospital, Rourkela, Odisha, India
| | - Jabamani Bage
- Center for the Study of Complex Malaria in India, Ispat General Hospital, Rourkela, Odisha, India
| | - Sameer Maharana
- Center for the Study of Complex Malaria in India, Ispat General Hospital, Rourkela, Odisha, India
| | - Angelika Seitz
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Ian W Turnbull
- North Manchester General Hospital, Manchester, United Kingdom
| | - Arjen M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford, United Kingdom
| | - Himanshu Gupta
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lukas Pirpamer
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Sanjib Mohanty
- Center for the Study of Complex Malaria in India, Ispat General Hospital, Rourkela, Odisha, India
| | - Samuel C Wassmer
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Gordon P, Venancio VP, Mertens-Talcott SU, Coté G. Portable bright-field, fluorescence, and cross-polarized microscope toward point-of-care imaging diagnostics. J Biomed Opt 2019; 24:1-8. [PMID: 31564071 PMCID: PMC6997630 DOI: 10.1117/1.jbo.24.9.096502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/04/2019] [Indexed: 05/16/2023]
Abstract
Emerging technologies are enabling the feasibility of new types of point-of-care diagnostic devices. A portable, multimodal microscopy platform intended for use in remote diagnostic applications is presented. Use of such a system could bring high-quality microscopy to field use for diseases such as malaria, allowing better diagnostic and surveillance information to be gathered. The microscope was designed using off-the-shelf components and a manual filter selection to generate bright-field, fluorescent, and cross-polarized images of samples mounted to microscopy slides. Design parameters for the system are discussed, and characterization is performed using standardized imaging targets, multimodal phantoms, and blood smears simulating those used in malaria diagnosis. The microscope is shown to be able to image below element 9-3 of a 1951 U.S. Air Force target, indicating that the system is capable of resolving features < 775 nm. Morphological indicators of Plasmodium falciparum can be visualized in images from each modality and combined into high-contrast composite images. To optimize parasitic feature contrast across all three imaging modes, several different staining techniques were compared, with results indicating that use of a single nucleic acid binding fluorophore is preferable.
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Affiliation(s)
- Paul Gordon
- Texas A&M University, Department of Biomedical Engineering, Optical Biosensing Laboratory, College Station, Texas, United States
| | - Vinicius Paula Venancio
- Texas A&M University, Department of Nutrition and Food Science, College Station, Texas, United States
| | | | - Gerard Coté
- Texas A&M University, Department of Biomedical Engineering, Optical Biosensing Laboratory, College Station, Texas, United States
- Texas A&M Engineering Experiment Station, Center for Remote Health Technologies and Systems, College Station, Texas, United States
- Address all correspondence to Gerard Coté, E-mail:
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Gopakumar GP, Swetha M, Sai Siva G, Sai Subrahmanyam GRK. Convolutional neural network-based malaria diagnosis from focus stack of blood smear images acquired using custom-built slide scanner. J Biophotonics 2018; 11:e201700003. [PMID: 28851134 DOI: 10.1002/jbio.201700003] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 07/23/2017] [Accepted: 08/24/2017] [Indexed: 05/24/2023]
Abstract
The present paper introduces a focus stacking-based approach for automated quantitative detection of Plasmodium falciparum malaria from blood smear. For the detection, a custom designed convolutional neural network (CNN) operating on focus stack of images is used. The cell counting problem is addressed as the segmentation problem and we propose a 2-level segmentation strategy. Use of CNN operating on focus stack for the detection of malaria is first of its kind, and it not only improved the detection accuracy (both in terms of sensitivity [97.06%] and specificity [98.50%]) but also favored the processing on cell patches and avoided the need for hand-engineered features. The slide images are acquired with a custom-built portable slide scanner made from low-cost, off-the-shelf components and is suitable for point-of-care diagnostics. The proposed approach of employing sophisticated algorithmic processing together with inexpensive instrumentation can potentially benefit clinicians to enable malaria diagnosis.
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Affiliation(s)
| | - Murali Swetha
- Department of Instrumentation and Applied Physics, Indian Institute of Science, Bengaluru, India
| | - Gorthi Sai Siva
- Department of Instrumentation and Applied Physics, Indian Institute of Science, Bengaluru, India
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Li C, Chen S, Klemba M, Zhu Y. Integrated quantitative phase and birefringence microscopy for imaging malaria-infected red blood cells. J Biomed Opt 2016; 21:90501. [PMID: 27598559 DOI: 10.1117/1.jbo.21.9.090501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/15/2016] [Indexed: 05/09/2023]
Abstract
A dual-modality birefringence/phase imaging system is presented. The system features a crystal retarder that provides polarization mixing and generates two interferometric carrier waves in a single signal spectrum. The retardation and orientation of sample birefringence can then be measured simultaneously based on spectral multiplexing interferometry. Further, with the addition of a Nomarski prism, the same setup can be used for quantitative differential interference contrast (DIC) imaging. Sample phase can then be obtained with two-dimensional integration. In addition, birefringence-induced phase error can be corrected using the birefringence data. This dual-modality approach is analyzed theoretically with Jones calculus and validated experimentally with malaria-infected red blood cells. The system generates not only corrected DIC and phase images, but a birefringence map that highlights the distribution of hemozoin crystals.
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Affiliation(s)
- Chengshuai Li
- Virginia Tech, The Bradley Department of Electrical and Computer Engineering, 1185 Perry Street, Blacksburg, Virginia 24061, United States
| | - Shichao Chen
- Virginia Tech, The Bradley Department of Electrical and Computer Engineering, 1185 Perry Street, Blacksburg, Virginia 24061, United States
| | - Michael Klemba
- Virginia Tech, Department of Biochemistry, 340 West Campus Drive, Blacksburg, Virginia 24061, United States
| | - Yizheng Zhu
- Virginia Tech, The Bradley Department of Electrical and Computer Engineering, 1185 Perry Street, Blacksburg, Virginia 24061, United States
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Laothamatas J, Sammet CL, Golay X, Van Cauteren M, Lekprasert V, Tangpukdee N, Krudsood S, Leowattana W, Wilairatana P, Swaminathan SV, DeLaPaz RL, Brown TR, Looareesuwan S, Brittenham GM. Transient lesion in the splenium of the corpus callosum in acute uncomplicated falciparum malaria. Am J Trop Med Hyg 2014; 90:1117-1123. [PMID: 24615139 PMCID: PMC4047739 DOI: 10.4269/ajtmh.13-0665] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/07/2014] [Indexed: 02/05/2023] Open
Abstract
Patients with acute uncomplicated Plasmodium falciparum malaria have no evident neurologic disorder, vital organ dysfunction, or other severe manifestations of infection. Nonetheless, parasitized erythrocytes cytoadhere to the endothelium throughout their microvasculature, especially within the brain. We aimed to determine if 3 Tesla magnetic resonance imaging studies could detect evidence of cerebral abnormalities in these patients. Within 24 hours of admission, initial magnetic resonance imaging examinations found a lesion with restricted water diffusion in the mid-portion of the splenium of the corpus callosum of 4 (40%) of 10 male patients. The four patients who had a splenial lesion initially had evidence of more severe hemolysis and thrombocytopenia than the six patients who had no apparent abnormality. Repeat studies four weeks later found no residua of the lesions and resolution of the hematologic differences. These observations provide evidence for acute cerebral injury in the absence of severe or cerebral malaria.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Sornchai Looareesuwan
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Institute of Neurology, University College London, London, United Kingdom; Philips Healthcare, Best, The Netherlands; The Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Departments of Radiology and Pediatrics and Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
| | - Gary M. Brittenham
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Institute of Neurology, University College London, London, United Kingdom; Philips Healthcare, Best, The Netherlands; The Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Departments of Radiology and Pediatrics and Medicine, Columbia University College of Physicians and Surgeons, New York, New York; Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina
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Jones MWM, Abbey B, Gianoncelli A, Balaur E, Millet C, Luu MB, Coughlan HD, Carroll AJ, Peele AG, Tilley L, van Riessen GA. Phase-diverse Fresnel coherent diffractive imaging of malaria parasite-infected red blood cells in the water window. Opt Express 2013; 21:32151-32159. [PMID: 24514809 DOI: 10.1364/oe.21.032151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Phase-diverse Fresnel coherent diffractive imaging has been shown to reveal the structure and composition of biological specimens with high sensitivity at nanoscale resolution. However, the method has yet to be applied using X-ray illumination with energy in the so-called 'water-window' that lies between the carbon and oxygen K edges. In this range, differences in the strength of the X-ray interaction for protein based biological materials and water is increased. Here we demonstrate a proof-of-principle application of FCDI at an X-ray energy within the water-window to a dehydrated cellular sample composed of red blood cells infected with the trophozoite stage of the malaria parasite, Plasmodium falciparum. Comparison of the results to both optical and electron microscopy shows that the correlative imaging methods that include water-window FCDI will find utility in studying cellular architecture.
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Abstract
We report a 7-year-old girl who presented with features of acute acalculous cholecystitis. She was found to be positive for Plasmodium falciparum. To the best of our knowledge, this is the first report of acalculous cholecystitis caused by P. falciparum in a child.
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Affiliation(s)
- Abhijeet Saha
- Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India.
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Bonnard P, Guiard-Schmid JB, Develoux M, Rozenbaum W, Pialoux G. Splenic infarction during acute malaria. Trans R Soc Trop Med Hyg 2005; 99:82-6. [PMID: 15550267 DOI: 10.1016/j.trstmh.2004.06.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Revised: 04/28/2004] [Accepted: 06/03/2004] [Indexed: 11/20/2022] Open
Abstract
Malaria is the most frequent cause of fever among travellers returning from tropical countries. Each year about 7000 cases are notified in France, of which 90% are due to Plasmodium falciparum. We describe the case of a Caucasian female patient with no previous exposure to malaria in whom splenic infarction occurred during effective antimalarial treatment for initially uncomplicated acute malaria. Management was restricted to close clinical monitoring and analgesia (subcutaneous morphine). Imaging abnormalities resolved within a few months. We found seven other such cases in the literature. All seven patients were younger and splenic infarction occurred later than in the case we describe. Clinical outcome was favourable in all the cases. It is noteworthy that this rare complication can occur despite appropriate antimalarial prophylaxis and treatment. There are no known predictive signs. Clinicians must be aware that left hypochondrial pain occurring during treatment for acute malaria may be due to splenic infarction.
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Affiliation(s)
- Philippe Bonnard
- Service de Maladies Infectieuses et Tropicales, Université Pierre et Marie Curie, Hôpital Tenon (AP-HP), 4 rue de la Chine, 75020 Paris, France.
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Richter J, de Bernardis C, Sagir A, Walter S, Savalli E, Häussinger D. Is ultrasound a useful adjunct for assessing malaria patients? Parasitol Res 2004; 94:349-53. [PMID: 15549382 DOI: 10.1007/s00436-004-1208-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Accepted: 06/08/2004] [Indexed: 12/17/2022]
Abstract
The value of ultrasonography as an adjunct for diagnosis and monitoring malaria was investigated. In all, 118 patients (male/female 65/53; age 2-78 years, median 29 years) with malaria underwent a standardised abdominal ultrasound examination at baseline. In 62 out of 118 patients, ultrasonography was repeated 21 days later. In the results at baseline, huge splenomegaly with firm organ consistency, consistent with hyperreactive malarious splenomegaly syndrome, was observed in two Cameroonese children. In the other 116 patients, the most common finding was non-specific splenomegaly (96/116, 82.76%), occurring more frequently in non-immune patients (71/78, 91.03%) than in patients who had grown up in malaria-endemic areas (25/38, 65.79%; P<0.002). No correlation was found between liver or spleen size and any clinical parameter. The results on day 21 show that, although splenomegaly after therapy persisted more frequently in patients with malaria recrudescence or relapse (8/8, 100%) than in patients cured (32/54, 59.26%; P<0.0421), the practical value of this finding is questionable. Ultrasonography cannot be regarded as a first-line diagnostic method in patients with malaria.
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Affiliation(s)
- Joachim Richter
- Tropical Medicine Unit, Clinic for Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University, 40225 Duesseldorf, Germany.
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Kachawaha S, Pokharana R, Rawat N, Garg P, Badjatiya H, Kochar DK. Ultrasonography in malarial hepatitis. Indian J Gastroenterol 2003; 22:110. [PMID: 12839391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Dorman EK, Shulman CE, Kingdom J, Bulmer JN, Mwendwa J, Peshu N, Marsh K. Impaired uteroplacental blood flow in pregnancies complicated by falciparum malaria. Ultrasound Obstet Gynecol 2002; 19:165-170. [PMID: 11876809 DOI: 10.1046/j.0960-7692.2001.00545.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE In endemic areas, maternal malaria infection is usually asymptomatic. However, it is known that infected maternal erythrocytes sequester in the intervillous space of the placenta. There is a strong association between placental malaria infection and both low birth weight (LBW) and severe maternal anemia. We aimed to determine whether impaired uteroplacental blood flow might account for the low infant birth weight associated with maternal falciparum malaria infection. METHODS This observational study was carried out during a large double-blind, randomized, controlled trial of an antimalarial drug intervention for primigravidae. Nine hundred and ninety-five women were recruited from the antenatal clinic at a district hospital on the Kenya coast and had at least one Doppler ultrasound scan. Uterine artery resistance index and the presence or absence of a diastolic notch were recorded. In the third trimester, blood was taken for hemoglobin and malaria film. RESULTS Malaria infection at 32-35 weeks of gestation was associated with abnormal uterine artery flow velocity waveforms on the day of blood testing (relative risk (RR) 2.11, 95% confidence interval (CI) 1.24-3.59, P = 0.006). This association persisted after controlling for pre-eclampsia. Impaired uteroplacental blood flow in the women studied was also predictive of poor perinatal outcome, including low birth weight, preterm delivery and perinatal death. The risk of preterm delivery in women with histological evidence of past placental malaria infection was more than twice that of women without infection (RR 2.33, 95% CI 1.31-4.13, P = 0.004). CONCLUSIONS Uteroplacental hemodynamics are altered in the presence of maternal falciparum malaria infection. This may account for some of the excess of LBW babies observed in malaria endemic areas. Strategies that prevent or clear placental malaria may confer perinatal benefit through preservation of placental function.
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Affiliation(s)
- E K Dorman
- Kenya Medical Research Institute, Centre for Geographical Medicine Research, Coast, Kilifi, Kenya.
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Arbeille P, Carles G, Bousquet F, Frigue V. [Fetal circulation and malaria]. J Gynecol Obstet Biol Reprod (Paris) 1998; 26:697-703. [PMID: 9471432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To quantity the fetal vascular changes during flare-up, and to evaluate the sensitivity and the specificity of Doppler indices for the prediction of acute fetal distress at the end of the pregnancy. METHOD Every day of flare-up the umbilical resistance (Rp), cerebral resistance (Rc), cerebro-placental ratio (CPR = Rc/Rp), and hypoxia index (HI = delta % CPR x crisis duration) were calculated. RESULTS Twenty-three pregnancies were investigated at St Laurent du Maroni Hospital (French Guiana). During flare-ups the Doppler placental resistance increased (placental disorder), cerebral resistance decreased (vasodilation), CPR decreased (flow redistribution toward the brain), and HI increased. An abnormal CPR (< 1) was associated with abnormal fetal heart rate (FHR) in 61.5% of the cases, a CPR > 1 was associated with a normal FHR in 80% of the cases. (sensitivity: 80%, specificity 61%). A CPR < 1 was associated with one of the abnormalities (abnormal FHR, cesarean section, abnormal Apgar) in 71% of the cases, a CPR > 1 was associated with normal delivery in 55% of the cases (sensitivity: 71.4%, Specificity 55%). A HI higher than 150 was associated with abnormal FHR in 75% of the cases, a HI < 150 was associated with normal FHR in 90% of the cases (sensitivity: 89%, specificity: 77%). Lastly the combination (HI > 150 + CPR < 1) was associated with abnormal FHR in 80% of the cases, 1 or 2 of these parameters were associated with normal FHR in 84.6% of the cases (sensitivity: 80%, specificity: 84%). The minimum CPR and the HI during malaria flare-up can be used to predict acute fetal distress at delivery.
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Affiliation(s)
- P Arbeille
- INSERM U316, Département Médecine Nucléaire et Ultrasons, CHU Trousseau, Tours
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Abstract
The mechanisms of death and neurologic sequelae in African children with cerebral malaria are undetermined. Because pathologic features are confined to the cerebral vasculature, perturbations in cerebral hemodynamics may be responsible. We compared the transcranial Doppler findings in 50 children with cerebral malaria with those of 115 conscious Kenyan children. In addition, 10 children with cerebral malaria were studied during intracranial pressure monitoring and nine children were studied during the agonal stages. In the children with cerebral malaria, cerebral blood flow velocity was increased in 30%, usually associated with seizures. Of the 11 children who developed neurologic sequelae, six had sonographic abnormalities associated with lateralizing deficits, including four children with hemiparesis (in two children the contralateral middle cerebral artery could not be insonated and two had transient increases in blood flow velocity associated with seizures). In the children with severe intracranial hypertension, there was a significant linear relationship between the cerebral perfusion pressure and blood flow velocity, suggesting that autoregulation was impaired. Sonographic features of progressive intracranial hypertension, were observed in three children with cerebral malaria who died. Perturbations of cerebral hemodynamics are associated with a poor outcome in Kenyan children with cerebral malaria.
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MESH Headings
- Blood Flow Velocity
- Cerebrovascular Circulation
- Child
- Child, Preschool
- Coma/diagnostic imaging
- Coma/etiology
- Coma/physiopathology
- Encephalocele/diagnostic imaging
- Encephalocele/etiology
- Encephalocele/physiopathology
- Female
- Hemiplegia/diagnostic imaging
- Hemiplegia/etiology
- Hemiplegia/physiopathology
- Humans
- Infant
- Intracranial Pressure
- Ischemic Attack, Transient/diagnostic imaging
- Ischemic Attack, Transient/etiology
- Ischemic Attack, Transient/physiopathology
- Kenya
- Malaria, Cerebral/complications
- Malaria, Cerebral/diagnostic imaging
- Malaria, Cerebral/mortality
- Malaria, Cerebral/physiopathology
- Malaria, Falciparum/complications
- Malaria, Falciparum/diagnostic imaging
- Malaria, Falciparum/mortality
- Malaria, Falciparum/physiopathology
- Male
- Seizures/diagnostic imaging
- Seizures/etiology
- Seizures/physiopathology
- Ultrasonography, Doppler, Transcranial
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Affiliation(s)
- C R Newton
- Kenya Medical Research Institute, Clinical Research Center, Kilifi, Kenya
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