MRI and eye exams help doctors in Malawi diagnose and treat children with cerebral malaria
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A child who has fully recovered from cerebral malaria demonstrates the MRI in Malawi.
Credit: John Robert Williams |
The incidence of malaria increases in areas, like Malawi, where the rainy season coincides with high temperatures. NIAID grantee Terrie Taylor, D.O., Distinguished Professor of Internal Medicine, Michigan State University, is an osteopathic physician who spends each rainy season working at Queen Elizabeth Central Hospital, Malawi, where she treats patients with malaria, most of them children under the age of 5, who suffer from cerebral malaria.
The most severe form of the disease, cerebral malaria, causes coma and sometimes death. Other diseases such as yellow fever and encephalitis mimic its symptoms. Adding to the diagnostic challenges faced by physicians, malaria infection does not always cause symptoms, especially among people in heavily affected countries who develop partial immunity.
To look at the damage malaria does to a child, Dr. Taylor and colleagues study the child’s brain. Dr. Taylor has found that 25 percent of children who were thought to have died from cerebral malaria, upon autopsy, actually died of infections, diseases, or conditions unrelated to malaria. The lack of diagnostic tools available to doctors in Malawi may have largely contributed to the misdiagnosis of patients. That changed, however, in June 2008, when a new magnetic resonance imaging (MRI) unit, the first MRI machine ever to come to Malawi, was put into operation. Supported by NIAID funding, the MRI not only lets Dr. Taylor and other clinicians assess malaria’s damage, it also helps diagnose a wide range of illnesses so that physicians can prescribe proper treatments for their patients.
In other work, Dr. Taylor was able to detect signs of severe malaria through eye exams. She and her colleagues checked comatose children for malaria symptoms in the backs of their eyes. They discovered four findings to use in assessing the severity of cerebral malaria in children who were in a coma and who had malaria parasites in their blood. The findings included ruptured blood vessels in the retina, changes in blood vessel color, whitening of the retina, and swelling of the optic nerve. Dr. Taylor said the eye exam provides a reliable way to diagnose the disease—the more severe the retinal symptoms, the longer it took the children to recover from their coma, or the more likely they were to die.
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