Biswas J, Fogla R, Srinivasan P, Narayan S, Haranath K, Badrinath V
Medical and Vision Research Foundations, Madras, India.
Ophthalmology. 1996 Sep;103(9):1471-5. doi: 10.1016/s0161-6420(96)30481-8.
Clinical and histopathologic findings of ocular lesions in malaria rarely have been described. This study reports lesions in three patients with malaria, with a histopathologic study of eyes obtained at autopsy of one of these patients.
Various ocular lesions were documented in three patients with malarial infection, with histopathologic study of one patient. In all three patients, the diagnosis of malaria was confirmed by the demonstration of malarial parasites in peripheral smears and by fluorescent microscopy of acridine orange-stained buffy coat preparations of venous blood.
Multiple superficial blotchy retinal hemorrhages over the posterior pole were seen in the first patient, whereas acute bilateral panuveitis and secondary glaucoma were seen in the second, which on resolution showed multiple blotchy superficial retinal hemorrhages with perivasculitis. The third patient had cerebral malaria and was found to have subconjunctival and retinal hemorrhages. This patient died of pulmonary thromboembolism, and the eyes were obtained at autopsy. On gross examination, there were multiple retinal hemorrhages in the posterior pole. Histopathologic study showed cytoadherence of parasitized erythrocytes as well as schizonts and gametocytes of Plasmodium vivax within the retinal and choroidal blood vessels.
The authors' findings suggest that patients with unexplained blotchy retinal hemorrhages should be investigated for malarial infection, especially if they reside or have travelled in endemic areas.
疟疾眼部病变的临床和组织病理学表现鲜有描述。本研究报告了3例疟疾患者的眼部病变情况，并对其中1例患者尸检时获取的眼睛进行了组织病理学研究。
记录了3例疟疾感染患者的各种眼部病变情况，并对其中1例患者进行了组织病理学研究。在所有3例患者中，通过外周血涂片发现疟原虫以及静脉血吖啶橙染色血沉棕黄层涂片的荧光显微镜检查确诊为疟疾。
第1例患者后极部可见多发性浅层斑片状视网膜出血；第2例患者出现急性双侧全葡萄膜炎和继发性青光眼，炎症消退后可见多发性斑片状浅层视网膜出血伴血管周围炎。第3例患者患有脑型疟疾，发现有结膜下和视网膜出血。该患者死于肺血栓栓塞，尸检时获取了眼睛。大体检查发现后极部有多处视网膜出血。组织病理学研究显示，视网膜和脉络膜血管内存在被寄生红细胞的细胞黏附现象以及间日疟原虫的裂殖体和配子体。
作者的研究结果表明，对于不明原因的斑片状视网膜出血患者，应进行疟疾感染调查，特别是如果他们居住在或曾前往疟疾流行地区。
