Ultrasound findings in Plasmodium falciparum malaria: a pilot study
Sarah Murphy1, Christine Cserti-Gazdewich, Aggrey Dhabangi
1Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. samurphy@partners.org
Insights
Hand-carried ultrasound can help assess children with acute malaria, detecting increased optic nerve sheath diameter and accurately measuring spleen size. This technology aids in risk stratification and monitoring treatment in pediatric malaria cases.
Area of Science:
- Pediatric infectious diseases
- Medical imaging technology
- Point-of-care diagnostics
Background:
- Acute Plasmodium falciparum malaria causes significant mortality in children under five globally.
- Hand-carried ultrasound offers diagnostic capabilities in underresourced settings.
- Assessing malaria severity and complications in children requires effective tools.
Purpose of the Study:
- To evaluate the utility of hand-carried ultrasound in assessing pediatric acute malaria.
- To explore ultrasound markers for risk stratification and patient classification.
- To investigate the role of ultrasound in monitoring treatment response.
Main Methods:
- Pilot observational study involving 33 hospitalized children (6 months-12 years) with acute P. falciparum malaria.
- Targeted bedside ultrasound examination including optic nerve sheath diameter, transcranial Doppler, cardiac, and abdominal ultrasound.
- Clinical data collection alongside ultrasound measurements.
Main Results:
- Increased optic nerve sheath diameter was found in one-third of malaria patients, and 100% of cerebral malaria cases.
- Cardiac function was not depressed, and pulmonary hypertension was not detected.
- Ultrasound measurement of spleen size was more accurate than palpation, revealing a lower incidence of splenomegaly (24% vs. 48%).
Conclusions:
- Targeted ultrasound, focusing on optic nerve sheath diameter and spleen size, is valuable for pediatric malaria assessment.
- This technology can aid in patient classification, risk stratification, and research.
- Further studies are warranted to fully establish the role of ultrasound in managing pediatric malaria.
Objective:
To investigate whether hand-carried ultrasound technology may be valuable in the assessment of children with acute malaria. Every year, approximately 800,000 children under the age of 5 yrs die of complications of Plasmodium falciparum malaria infection. The advent of hand-carried ultrasound technology has made diagnostic ultrasonography possible in underresourced settings.
Design:
We performed a pilot observational study collecting clinical data and performing ultrasound examinations on children diagnosed with P. falciparum malaria infection. The targeted ultrasound examination included measurement of optic nerve sheath diameter, color transcranial Doppler insonation of the cerebral vasculature, cardiac ultrasound, and abdominal ultrasound.
Setting:
Pediatric acute care unit of Mulago Hospital in Kampala, Uganda.
Patients:
Thirty-three hospitalized children between the ages of 6 months and 12 yrs with documented acute P. falciparum infection.
Intervention:
Targeted bedside ultrasound examination.
Measurements And Main Results:
Increased optic nerve sheath diameter was observed in one third of all patients with malaria and in 100% of the patients diagnosed with cerebral malaria. Although higher-than-normal cerebral blood flow velocities were demonstrated in three (25%) of 12 patients with severe anemia, most patients demonstrated a normal cerebral blood flow velocity, suggesting a blunted response to anemia. We did not find evidence of pulmonary hypertension by cardiac ultrasound, and cardiac function did not seem depressed, even among patients with severe anemia and lactic acidosis. Finally, spleen size as determined by palpation significantly overestimated the true incidence of splenomegaly as measured by ultrasound (48% and 24%, respectively).
Conclusions:
A targeted ultrasound examination focusing on optic nerve sheath diameter, color transcranial Doppler, cardiac ultrasound, and spleen size may prove useful for patient classification, risk stratification, research studies, and treatment monitoring in pediatric malaria. More studies should be done.
