Publication:
Brain Magnetic Resonance Imaging Reveals Different Courses of Disease in Pediatric and Adult Cerebral Malaria

Issued Date

2021-10-05

Resource Type

Article

ISSN

15376591

DOI

10.1093/cid/ciaa1647

Other identifier(s)

2-s2.0-85118283369

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Vol.73, No.7 (2021), e2387-e2396

Suggested Citation

Praveen K. Sahu, Angelika Hoffmann, Megharay Majhi, Rajyabardhan Pattnaik, Catriona Patterson, Kishore C. Mahanta, Akshaya K. Mohanty, Rashmi R. Mohanty, Sonia Joshi, Anita Mohanty, Jabamani Bage, Sameer Maharana, Angelika Seitz, Martin Bendszus, Steven A. Sullivan, Ian W. Turnbull, Arjen M. Dondorp, Himanshu Gupta, Lukas Pirpamer, Sanjib Mohanty, Samuel C. Wassmer Brain Magnetic Resonance Imaging Reveals Different Courses of Disease in Pediatric and Adult Cerebral Malaria. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Vol.73, No.7 (2021), e2387-e2396. doi:10.1093/cid/ciaa1647 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77769

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Title

Brain Magnetic Resonance Imaging Reveals Different Courses of Disease in Pediatric and Adult Cerebral Malaria

Author(s)

Praveen K. Sahu
 Angelika Hoffmann
 Megharay Majhi
 Rajyabardhan Pattnaik
 Catriona Patterson
 Kishore C. Mahanta
 Akshaya K. Mohanty
 Rashmi R. Mohanty
 Sonia Joshi
 Anita Mohanty
 Jabamani Bage
 Sameer Maharana
 Angelika Seitz
 Martin Bendszus
 Steven A. Sullivan
 Ian W. Turnbull
 Arjen M. Dondorp
 Himanshu Gupta
 Lukas Pirpamer
 Sanjib Mohanty
 Samuel C. Wassmer

Other Contributor(s)

Faculty of Tropical Medicine, Mahidol University
 Ispat General Hospital
 London School of Hygiene & Tropical Medicine
 Institute of Life Sciences India
 New York University
 University Hospital Bern
 Nuffield Department of Medicine
 North Manchester General Hospital
 Medizinische Universität Graz
 Universitätsklinikum Heidelberg

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.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/77769

Collections

Scopus 2021