Skip to main content
Top
Published in: Malaria Journal 1/2019

Open Access 01-12-2019 | Magnetic Resonance Imaging | Research

Brain magnetic resonance imaging in imported malaria

Authors: Andreas M. Frölich, Pinkus Tober-Lau, Michael Schönfeld, Thomas T. Brehm, Florian Kurth, Christof D. Vinnemeier, Marylyn M. Addo, Jens Fiehler, Thierry Rolling

Published in: Malaria Journal | Issue 1/2019

Login to get access

Abstract

Background

Previous studies have documented a spectrum of brain magnetic resonance imaging (MRI) abnormalities in patients with cerebral malaria, but little is known about the prevalence of such abnormalities in patients with non-cerebral malaria. The aim of this study was to assess the frequency of brain MRI findings in returning travellers with non-cerebral malaria.

Methods

A total of 17 inpatients with microscopically confirmed Plasmodium falciparum non-cerebral malaria underwent structural brain MRI at 3.0 Tesla, including susceptibility-weighted imaging (SWI). Presence of imaging findings was recorded and correlated with clinical findings and parasitaemia.

Results

Structural brain abnormalities included a hyperintense lesion of the splenium on T2-weighted imaging (n = 3) accompanied by visible diffusion restriction (n = 2). Isolated brain microhaemorrhage was detected in 3 patients. T2-hyperintense signal abnormalities of the white matter ranged from absent to diffuse (n = 10 had 0–5 lesions, n = 5 had 5–20 lesions and 2 patients had more than 50 lesions). Imaging findings were not associated with parasitaemia or HRP2 levels.

Conclusion

Brain MRI reveals a considerable frequency of T2-hyperintense splenial lesions in returning travellers with non-cerebral malaria, which appears to be independent of parasitaemia.
Literature
1.
go back to reference Taylor TE, Fu WJ, Carr RA, Whitten RO, Mueller JS, Fosiko NG, et al. Differentiating the pathologies of cerebral malaria by postmortem parasite counts. Nat Med. 2004;10:143–5.CrossRef Taylor TE, Fu WJ, Carr RA, Whitten RO, Mueller JS, Fosiko NG, et al. Differentiating the pathologies of cerebral malaria by postmortem parasite counts. Nat Med. 2004;10:143–5.CrossRef
2.
go back to reference Pongponratn E, Turner GD, Day NP, Phu NH, Simpson JA, Stepniewska K, et al. An ultrastructural study of the brain in fatal Plasmodium falciparum malaria. Am J Trop Med Hyg. 2003;69:345–59.CrossRef Pongponratn E, Turner GD, Day NP, Phu NH, Simpson JA, Stepniewska K, et al. An ultrastructural study of the brain in fatal Plasmodium falciparum malaria. Am J Trop Med Hyg. 2003;69:345–59.CrossRef
3.
go back to reference Cunnington AJ, Bretscher MT, Nogaro SI, Riley EM, Walther M. Comparison of parasite sequestration in uncomplicated and severe childhood Plasmodium falciparum malaria. J Infect. 2013;67:220–30.CrossRef Cunnington AJ, Bretscher MT, Nogaro SI, Riley EM, Walther M. Comparison of parasite sequestration in uncomplicated and severe childhood Plasmodium falciparum malaria. J Infect. 2013;67:220–30.CrossRef
4.
go back to reference Dondorp AM, Desakorn V, Pongtavornpinyo W, Sahassananda D, Silamut K, Chotivanich K, et al. Estimation of the total parasite biomass in acute falciparum malaria from plasma PfHRP2. PLoS Med. 2005;2:e204.CrossRef Dondorp AM, Desakorn V, Pongtavornpinyo W, Sahassananda D, Silamut K, Chotivanich K, et al. Estimation of the total parasite biomass in acute falciparum malaria from plasma PfHRP2. PLoS Med. 2005;2:e204.CrossRef
5.
go back to reference Hantson P, Hernalsteen D, Cosnard G. Reversible splenial lesion syndrome in cerebral malaria. J Neuroradiol. 2010;37:243–6.CrossRef Hantson P, Hernalsteen D, Cosnard G. Reversible splenial lesion syndrome in cerebral malaria. J Neuroradiol. 2010;37:243–6.CrossRef
6.
go back to reference Vyas S, Gupta V, Hondappanavar A, Sakhuja V, Bhardwaj N, Singh P, et al. Magnetic resonance imaging of cerebral malaria. J Emerg Med. 2012;42:e117–9.CrossRef Vyas S, Gupta V, Hondappanavar A, Sakhuja V, Bhardwaj N, Singh P, et al. Magnetic resonance imaging of cerebral malaria. J Emerg Med. 2012;42:e117–9.CrossRef
7.
go back to reference Yadav P, Sharma R, Kumar S, Kumar U. Magnetic resonance features of cerebral malaria. Acta Radiol. 2008;49:566–9.CrossRef Yadav P, Sharma R, Kumar S, Kumar U. Magnetic resonance features of cerebral malaria. Acta Radiol. 2008;49:566–9.CrossRef
8.
go back to reference Maude RJ, Barkhof F, Hassan MU, Ghose A, Hossain A, Abul Faiz M, et al. Magnetic resonance imaging of the brain in adults with severe falciparum malaria. Malar J. 2014;13:177.CrossRef Maude RJ, Barkhof F, Hassan MU, Ghose A, Hossain A, Abul Faiz M, et al. Magnetic resonance imaging of the brain in adults with severe falciparum malaria. Malar J. 2014;13:177.CrossRef
9.
go back to reference Laothamatas J, Sammet CL, Golay X, Van Cauteren M, Lekprasert V, Tangpukdee N, et al. Transient lesion in the splenium of the corpus callosum in acute uncomplicated falciparum malaria. Am J Trop Med Hyg. 2014;90:1117–23.CrossRef Laothamatas J, Sammet CL, Golay X, Van Cauteren M, Lekprasert V, Tangpukdee N, et al. Transient lesion in the splenium of the corpus callosum in acute uncomplicated falciparum malaria. Am J Trop Med Hyg. 2014;90:1117–23.CrossRef
10.
go back to reference Nickerson JP, Tong KA, Raghavan R. Imaging cerebral malaria with a susceptibility-weighted MR sequence. Am J Neuroradiol. 2009;30:e85–6.CrossRef Nickerson JP, Tong KA, Raghavan R. Imaging cerebral malaria with a susceptibility-weighted MR sequence. Am J Neuroradiol. 2009;30:e85–6.CrossRef
11.
go back to reference Potchen MJ, Kampondeni SD, Seydel KB, Haacke EM, Sinyangwe SS, Mwenechanya M, et al. 1.5 Tesla magnetic resonance imaging to investigate potential etiologies of brain swelling in pediatric cerebral malaria. Am J Trop Med Hyg. 2018;98:487–504.CrossRef Potchen MJ, Kampondeni SD, Seydel KB, Haacke EM, Sinyangwe SS, Mwenechanya M, et al. 1.5 Tesla magnetic resonance imaging to investigate potential etiologies of brain swelling in pediatric cerebral malaria. Am J Trop Med Hyg. 2018;98:487–504.CrossRef
12.
go back to reference Kurth F, Develoux M, Mechain M, Malvy D, Clerinx J, Antinori S, et al. Severe malaria in Europe: an 8-year multi-centre observational study. Malar J. 2017;16:57.CrossRef Kurth F, Develoux M, Mechain M, Malvy D, Clerinx J, Antinori S, et al. Severe malaria in Europe: an 8-year multi-centre observational study. Malar J. 2017;16:57.CrossRef
13.
go back to reference Marks ME, Armstrong M, Suvari MM, Batson S, Whitty JMC, Chiodini PL, et al. Severe imported falciparum malaria among adults requiring intensive care: a retrospective study at the hospital for tropical diseases, London. BMC Infect Dis. 2013;13:118.CrossRef Marks ME, Armstrong M, Suvari MM, Batson S, Whitty JMC, Chiodini PL, et al. Severe imported falciparum malaria among adults requiring intensive care: a retrospective study at the hospital for tropical diseases, London. BMC Infect Dis. 2013;13:118.CrossRef
14.
go back to reference WHO. Guidelines for the treatment of malaria. 3rd ed. Geneva: World Health Organization; 2015. WHO. Guidelines for the treatment of malaria. 3rd ed. Geneva: World Health Organization; 2015.
15.
go back to reference WHO. Communicable Diseases Cluster Severe falciparum malaria. Trans R Soc Trop Med Hyg. 2000;94(Suppl 1):S1–90. WHO. Communicable Diseases Cluster Severe falciparum malaria. Trans R Soc Trop Med Hyg. 2000;94(Suppl 1):S1–90.
16.
go back to reference Robert Koch Institut. Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2016. Berlin, 2017. Robert Koch Institut. Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2016. Berlin, 2017.
17.
go back to reference Potchen MJ, Kampondeni SD, Seydel KB, Birbeck GL, Hammond CA, Bradley WG, et al. Acute brain MRI findings in 120 Malawian children with cerebral malaria: new insights into an ancient disease. Am J Neuroradiol. 2012;33:1740–6.CrossRef Potchen MJ, Kampondeni SD, Seydel KB, Birbeck GL, Hammond CA, Bradley WG, et al. Acute brain MRI findings in 120 Malawian children with cerebral malaria: new insights into an ancient disease. Am J Neuroradiol. 2012;33:1740–6.CrossRef
18.
go back to reference Nandigam RN, Viswanathan A, Delgado P, Skehan ME, Smith EE, Rosand J, et al. MR imaging detection of cerebral microbleeds: effect of susceptibility-weighted imaging, section thickness, and field strength. Am J Neuroradiol. 2009;30:338–43.CrossRef Nandigam RN, Viswanathan A, Delgado P, Skehan ME, Smith EE, Rosand J, et al. MR imaging detection of cerebral microbleeds: effect of susceptibility-weighted imaging, section thickness, and field strength. Am J Neuroradiol. 2009;30:338–43.CrossRef
19.
go back to reference Vernooij MW, van der Lugt A, Ikram MA, Wielopolski PA, Niessen WJ, Hofman A, et al. Prevalence and risk factors of cerebral microbleeds: the Rotterdam Scan Study. Neurology. 2008;70:1208–14.CrossRef Vernooij MW, van der Lugt A, Ikram MA, Wielopolski PA, Niessen WJ, Hofman A, et al. Prevalence and risk factors of cerebral microbleeds: the Rotterdam Scan Study. Neurology. 2008;70:1208–14.CrossRef
20.
go back to reference Schrag M, Greer DM. Clinical associations of cerebral microbleeds on magnetic resonance neuroimaging. J Stroke Cerebrovasc Dis. 2014;23:2489–97.CrossRef Schrag M, Greer DM. Clinical associations of cerebral microbleeds on magnetic resonance neuroimaging. J Stroke Cerebrovasc Dis. 2014;23:2489–97.CrossRef
21.
go back to reference Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12:822–38.CrossRef Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12:822–38.CrossRef
Metadata
Title
Brain magnetic resonance imaging in imported malaria
Authors
Andreas M. Frölich
Pinkus Tober-Lau
Michael Schönfeld
Thomas T. Brehm
Florian Kurth
Christof D. Vinnemeier
Marylyn M. Addo
Jens Fiehler
Thierry Rolling
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Malaria Journal / Issue 1/2019
Electronic ISSN: 1475-2875
DOI
https://doi.org/10.1186/s12936-019-2713-2

Other articles of this Issue 1/2019

Malaria Journal 1/2019 Go to the issue