应用脑电图评估视网膜病变阴性脑疟疾患儿的昏迷病因。

IF 1.6 4区 医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Mrinmayee Takle, Alexander Andrews, Brittany A Riggle, Tesfaye Zelleke, Dana Harrar, Jiahui Zhang, Bo Zhang, Kyle J Wilson, Nicholas A V Beare, Terrie E Taylor, Karl B Seydel, Stephen Ray, Douglas G Postels
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引用次数: 0

摘要

对死于脑疟疾(CM)的儿童的尸检研究表明,患有疟疾性视网膜病变的儿童在脑血管系统中表现出高水平的隔离,而患有视网膜病变阴性的CM的儿童则表现出较低的隔离水平,这可能是非疟疾死亡原因。这表明,死于视网膜病变阴性CM的儿童有非疟疾昏迷病因,并伴有偶发寄生虫病,这在疟疾高传播地区很常见。随后的研究对这一论断提出了质疑,认为视网膜病变阴性的CM和视网膜病变阳性的CM是同一疾病病理生理学或宿主生物学的变体,都是由急性疟疾感染引起的。我们最近确定脑电图(EEG)可以用来区分疟疾昏迷(CM)和非疟疾昏迷。为了更好地了解急性疟疾感染在视网膜病变阴性CM的病理生理中的作用,我们比较了在伊丽莎白女王中心医院住院的3个月至14岁的马拉维儿童30分钟的脑电图记录的定性和定量脑电图结果,这些儿童患有视网膜病变阴性CM、视网膜病变阳性CM和非疟疾昏迷。定性和定量脑电图解释方法都不能区分视网膜病变阳性CM和视网膜病变阴性CM的儿童。相反,定量脑电图很容易将视网膜病变阴性CM患儿与非疟疾性昏迷患儿区分开来(接收工作特征曲线下面积为0.83)。结合定性和定量脑电图解释方法,脑电图区分视网膜病变阴性CM与非疟疾脑电图的能力增强(AUROC为0.87)。视网膜病变阴性CM患儿的脑电图与视网膜病变阳性CM患儿相似,与非疟疾性昏迷患儿的脑电图差异显著,支持急性疟疾感染在视网膜病变阴性CM中具有重要病理生理作用的假设。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Using Electroencephalography to Assess Coma Etiology in Children with Retinopathy-Negative Cerebral Malaria.

Autopsy studies of children dying of cerebral malaria (CM) have revealed that those with malarial retinopathy exhibited high levels of sequestration in the cerebral vasculature, whereas children with retinopathy-negative CM exhibited lower sequestration levels and possible nonmalarial causes of death. This suggests that children dying of retinopathy-negative CM have nonmalarial coma etiologies with concomitant incidental parasitemia, which is common in high malaria transmission areas. Subsequent studies have challenged this assertion, positing that retinopathy-negative CM and retinopathy-positive CM are variants of the same disease pathophysiology or host biology, both caused by acute malaria infection. We recently determined that electroencephalography (EEG) can be used to discriminate between a malarial coma (CM) and a nonmalarial coma. To better understand the contribution of acute malaria infection in the pathophysiology of retinopathy-negative CM, we compared qualitative and quantitative EEG findings from 30-minute EEG recordings of Malawian children aged 3 months to 14 years hospitalized at Queen Elizabeth Central Hospital with retinopathy-negative CM, retinopathy-positive CM, and nonmalarial coma. Neither qualitative nor quantitative EEG interpretation methods allow for the discrimination between children with retinopathy-positive CM and those with retinopathy-negative CM. Conversely, quantitative EEG readily differentiated children with retinopathy-negative CM from those with nonmalarial coma (area under the receiving operating characteristic [AUROC] curve of 0.83). When combining qualitative and quantitative EEG interpretation methods, the ability of EEG to distinguish retinopathy-negative CM from nonmalarial EEG increases (AUROC of 0.87). The EEGs of children with retinopathy-negative CM are similar to those of children with retinopathy-positive CM and significantly different from those of children with nonmalarial coma, supporting the hypothesis that acute malarial infection is pathophysiologically important in retinopathy-negative CM.

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来源期刊
American Journal of Tropical Medicine and Hygiene
American Journal of Tropical Medicine and Hygiene 医学-公共卫生、环境卫生与职业卫生
CiteScore
6.20
自引率
3.00%
发文量
508
审稿时长
3 months
期刊介绍: The American Journal of Tropical Medicine and Hygiene, established in 1921, is published monthly by the American Society of Tropical Medicine and Hygiene. It is among the top-ranked tropical medicine journals in the world publishing original scientific articles and the latest science covering new research with an emphasis on population, clinical and laboratory science and the application of technology in the fields of tropical medicine, parasitology, immunology, infectious diseases, epidemiology, basic and molecular biology, virology and international medicine. The Journal publishes unsolicited peer-reviewed manuscripts, review articles, short reports, images in Clinical Tropical Medicine, case studies, reports on the efficacy of new drugs and methods of treatment, prevention and control methodologies,new testing methods and equipment, book reports and Letters to the Editor. Topics range from applied epidemiology in such relevant areas as AIDS to the molecular biology of vaccine development. The Journal is of interest to epidemiologists, parasitologists, virologists, clinicians, entomologists and public health officials who are concerned with health issues of the tropics, developing nations and emerging infectious diseases. Major granting institutions including philanthropic and governmental institutions active in the public health field, and medical and scientific libraries throughout the world purchase the Journal. Two or more supplements to the Journal on topics of special interest are published annually. These supplements represent comprehensive and multidisciplinary discussions of issues of concern to tropical disease specialists and health issues of developing countries
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