{"doi":"10.1038/s41598-021-94495-9","title":"Cerebral malaria: insight into pathology from optical coherence tomography","abstract":"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.","journal":"Scientific Reports","year":2021,"id":174037,"datarank":0.7642719220271725,"base_score":3.1780538303479458,"endowment":3.1780538303479458,"self_citation_contribution":0.47670807455219194,"citation_network_contribution":0.2875638474749806,"self_endowment_contribution":0.47670807455219194,"citer_contribution":0.2875638474749806,"corpus_percentile":null,"corpus_rank":null,"citation_count":23,"citer_count":12,"citers_with_citation_signal":8,"citers_with_endowment":8,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9196,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":712928,"name":"Jack Gormley","orcid":"0000-0001-8602-7498","position":1,"is_corresponding":false},{"id":713607,"name":"Viral Sheth","orcid":null,"position":2,"is_corresponding":false},{"id":75973,"name":"Karl B. Seydel","orcid":"0000-0001-9859-9549","position":3,"is_corresponding":false},{"id":75970,"name":"Terrie E. Taylor","orcid":"0000-0001-7416-3986","position":4,"is_corresponding":false},{"id":497650,"name":"Nicholas A. V. Beare","orcid":"0000-0001-8086-990X","position":5,"is_corresponding":false},{"id":497649,"name":"Valentina Barrera","orcid":"0000-0003-0515-5901","position":6,"is_corresponding":false},{"id":713608,"name":"Frank A. Proudlock","orcid":null,"position":7,"is_corresponding":false},{"id":713609,"name":"Chatonda Manda","orcid":null,"position":8,"is_corresponding":false},{"id":54583,"name":"Simon Harding","orcid":"0000-0003-4676-1158","position":9,"is_corresponding":false},{"id":712929,"name":"Irène Gottlob","orcid":"0000-0003-3217-493X","position":10,"is_corresponding":false},{"id":713606,"name":"Zhanhan Tu","orcid":null,"position":0,"is_corresponding":true}],"reference_count":35,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-18T23:46:54.772014Z","pmid":"34344903","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}