Abstract
BackgroundPrevious 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.MethodsA 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.ResultsStructural 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.ConclusionBrain MRI reveals a considerable frequency of T2-hyperintense splenial lesions in returning travellers with non-cerebral malaria, which appears to be independent of parasitaemia.
Highlights
Previous studies have documented a spectrum of brain magnetic resonance imaging (MRI) abnormali‐ ties in patients with cerebral malaria, but little is known about the prevalence of such abnormalities in patients with non-cerebral malaria
Half (n = 8) were immigrants from malaria-endemic countries who were visiting friends and relatives (VFR), while the other half were travellers not originating from malaria-endemic countries
The present study describes the frequency of brain MRI abnormalities in a cohort of returning travellers with non-cerebral malaria
Summary
Previous studies have documented a spectrum of brain magnetic resonance imaging (MRI) abnormali‐ ties 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. Malaria is a systemic parasitic disease involving multiple organ systems in severe cases. It is thought to be at least partially related to the sequestration of infected erythrocytes in the microvasculature of Frölich et al Malar J (2019) 18:74 to microhaemorrhages, may reveal brain microhaemorrhages in patients with cerebral malaria [10, 11]. Due to the absence of these factors, returning travellers with malaria form a more homogeneous population in which to investigate cerebral involvement by magnetic resonance imagin (MRI) without a confounding effect
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