Predicting Acute and Post-Recovery Outcomes in Cerebral Malaria and Other Comas by Optical Coherence Tomography (OCT in CM) - A protocol for an observational cohort study of Malawian children

Kyle J Wilson; Zhanhan Tu; Emmie Mbale; Priscilla P Mhango; Petros Kayange; Melissa J Gladstone; Simon Harding; Irene Gottlob; Marta Garcia-Finana; Yaochun Shen; Terrie E Taylor; Karl B Seydel; Yalin Zheng; Nicholas Av Beare

doi:10.12688/wellcomeopenres.19166.1

Predicting Acute and Post-Recovery Outcomes in Cerebral Malaria and Other Comas by Optical Coherence Tomography (OCT in CM) - A protocol for an observational cohort study of Malawian children

Wellcome Open Res. 2023 Apr 14:8:172. doi: 10.12688/wellcomeopenres.19166.1. eCollection 2023.

Authors

Kyle J Wilson^{1

2}, Zhanhan Tu³, Emmie Mbale⁴, Priscilla P Mhango⁵, Petros Kayange⁵, Melissa J Gladstone⁶, Simon Harding^{1

7}, Irene Gottlob⁸, Marta Garcia-Finana⁹, Yaochun Shen¹⁰, Terrie E Taylor^{11

12}, Karl B Seydel^{11

12}, Yalin Zheng^{1

13}, Nicholas Av Beare^{1

7}

Affiliations

¹ Eye & Vision Science, University of Liverpool, Liverpool, England, L69 7TX, UK.
² Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Southern Region, PO Box 30096, Malawi.
³ Ulverscroft Eye Unit, University of Leicester, Leicester, England, LE2 7LX, UK.
⁴ Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Southern Region, P/Bag 360, Malawi.
⁵ Department of Ophthalmology, Kamuzu University of Health Sciences, Blantyre, Southern Region, P/Bag 360, Malawi.
⁶ Women's and Children's Health, University of Liverpool, Liverpool, England, L69 7TX, UK.
⁷ St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, L7 8YA, UK.
⁸ Cooper Neurological Institute, Cherry Hill, New Jersey, 08002, USA.
⁹ Department of Health Data Science, University of Liverpool, Liverpool, England, L69 3GF, UK.
¹⁰ Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool, England, L69 3GJ, UK.
¹¹ College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, 4882, USA.
¹² Blantyre Malaria Project, Blantyre, Southern Region, P/Bag 360, Malawi.
¹³ Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, England, L69 7TX, UK.

Abstract

Cerebral malaria (CM) remains a significant global health challenge with high morbidity and mortality. Malarial retinopathy has been shown to be diagnostically and prognostically significant in the assessment of CM. The major mechanism of death in paediatric CM is brain swelling. Long term morbidity is typically characterised by neurological and neurodevelopmental sequelae. Optical coherence tomography can be used to quantify papilloedema and macular ischaemia, identified as hyperreflectivity. Here we describe a protocol to test the hypotheses that quantification of optic nerve head swelling using optical coherence tomography can identify severe brain swelling in CM, and that quantification of hyperreflectivity in the macula predicts neurodevelopmental outcomes post-recovery. Additionally, our protocol includes the development of a novel, low-cost, handheld optical coherence tomography machine and artificial intelligence tools to assist in image analysis.

Keywords: artificial intelligence; brain swelling; cerebral malaria; intracranial pressure; malarial retinopathy; optical coherence tomography.

Grants and funding

This study is funded by the Wellcome Trust’s Investigator Award in Science Programme (Grant Number: 222530/Z/21/Z).