Case Report: Severe Optic Neuritis after Multiple Episodes of Malaria in a Traveler to Africa

Chuan-bin Sun Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China;

Search for other papers by Chuan-bin Sun in
Current site
Google Scholar
PubMed
Close
,
Zhiqiong Ma Department of Ophthalmology, Xiaoshan Hospital, Hangzhou, China;

Search for other papers by Zhiqiong Ma in
Current site
Google Scholar
PubMed
Close
, and
Zhe Liu Department of Ophthalmology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China

Search for other papers by Zhe Liu in
Current site
Google Scholar
PubMed
Close
Restricted access

ABSTRACT.

Although local transmission of malaria has been eliminated, the disease is frequently imported to China by Chinese travelers returning from Africa. Optic neuritis (ON) is occasionally reported in malarial cases and usually shows good visual recovery and prognosis. Herein, we report severe visual loss with poor recovery due to bilateral ON in a malarial patient who traveled from Nigeria. While he was still in Nigeria, his visual acuity dropped to no light perception in both eyes after the third episode of malaria, which was confirmed by a positive blood smear for malarial parasites. His general condition gradually improved after a 6-day course of artesunate therapy. However, visual acuity in both eyes remained unchanged after artesunate therapy alone, with gradual improvement subsequently shown after pulse steroid therapy. Our case indicates that early antimalarial drugs combined with pulse steroid therapy may be of great importance for good visual recovery in ON cases after malarial infection.

Author Notes

Address correspondence to Zhe Liu, Department of Ophthalmology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou 310015, China. E-mail: doctorliuzhe@126.com

Authors’ addresses: Chuan-bin Sun, Eye Center, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China, E-mail: sunshine2012@zju.edu.cn. Zhiqiong Ma, Department of Ophthalmology, Xiaoshan Hospital, Hangzhou, China, E-mail: mazhiqiong@live.com. Zhe Liu, Department of Ophthalmology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China, E-mail: doctorliuzhe@126.com.

  • 1.

    Eggenberger ER , 2019. Infectious optic neuropathies. Continuum (Minneap Minn) 25: 14221437.

  • 2.

    Kahloun R , Abroug N , Ksiaa I , Mahmoud A , Zeghidi H , Zaouali S , Khairallah M , 2015. Infectious optic neuropathies: a clinical update. Eye Brain 7: 5981.

    • Search Google Scholar
    • Export Citation
  • 3.

    Padhi TR , Das S , Sharma S , Rath S , Rath S , Tripathy D , Panda KG , Basu S , Besirli CG , 2017. Ocular parasitoses: a comprehensive review. Surv Ophthalmol 62: 161189.

    • Search Google Scholar
    • Export Citation
  • 4.

    Reis J , Spencer PS , Román GC , Buguet A , 2021. Environmental neurology in the tropics. J Neurol Sci 421: 117287.

  • 5.

    Kochar DK , Shubhakaran, Kumawat BL , Thanvi I , Joshi A , Vyas SP , 1998. Ophthalmoscopic abnormalities in adults with falciparum malaria. QJM 91: 845852.

    • Search Google Scholar
    • Export Citation
  • 6.

    Maude RJ et al., 2009. The spectrum of retinopathy in adults with Plasmodium falciparum malaria. Trans R Soc Trop Med Hyg 103: 665671.

  • 7.

    Faber H , Berens P , Rohrbach JM , 2022. Ocular changes as a diagnostic tool for malaria [in German]. Ophthalmologie 119: 693698.

  • 8.

    Lewallen S , Taylor TE , Molyneux ME , Wills BA , Courtright P , 1993. Ocular fundus findings in Malawian children with cerebral malaria. Ophthalmology 100: 857861.

    • Search Google Scholar
    • Export Citation
  • 9.

    Joshi V , Agurto C , Barriga S , Nemeth S , Soliz P , MacCormick IJ , Lewallen S , Taylor TE , Harding SP , 2017. Automated detection of malarial retinopathy in digital fundus images for improved diagnosis in Malawian children with clinically defined cerebral malaria. Sci Rep 7: 42703.

    • Search Google Scholar
    • Export Citation
  • 10.

    Chacko JG , Onteddu S , Rosenbaum ER , 2013. Bilateral optic neuritis due to malaria. J Neuroophthalmol 33: 266267.

  • 11.

    Cao S , Wang L , Wei S , 2015. Bilateral optic neuritis secondary to malaria parasite. Chin J Ocul Fundus Dis 31: 600601.

  • 12.

    Wadia PZ , 1990. Retrobulbar neuritis in two patients with falciparum malaria. J Assoc Physicians India 38: 800801.

  • 13.

    Kale VP , Bichile LS , Bajpai S , 2004. Falciparum malaria induced retrobulbar neuritis. J Postgrad Med 50: 150.

  • 14.

    Kasundra GM , Bhargava AN , Bhushan B , Shubhakaran K , Sood I , 2015. Post-Plasmodium vivax malaria cerebellar ataxia and optic neuritis: a new form of delayed cerebellar ataxia or cerebellar variant of acute disseminated encephalomyelitis? J Pediatr Neurosci 10: 5860.

    • Search Google Scholar
    • Export Citation
  • 15.

    Lewallen S , Bronzan RN , Beare NA , Harding SP , Molyneux ME , Taylor TE , 2008. Using malarial retinopathy to improve the classification of children with cerebral malaria. Trans R Soc Trop Med Hyg 102: 10891094.

    • Search Google Scholar
    • Export Citation
  • 16.

    Choudhury H , Panchal B , Doshi S , Pathengay A , 2019. Occlusion of the central retinal artery in Plasmodium falciparum malaria. BMJ Case Rep 12: e230137.

    • Search Google Scholar
    • Export Citation
  • 17.

    Flower B , Armstrong-James D , Dance C , Bremner F , Doherty T , 2011. Blind, breathless, and paralysed from benign malaria. Lancet 377: 438.

  • 18.

    Gallien S , Milea D , Thiebaut MM , Bricaire F , Le Hoang P , 2007. Brain and optic nerve ischemia in malaria with immune disorders. J Infect 54: e1e3.

    • Search Google Scholar
    • Export Citation
  • 19.

    Sun C , Qing X , Bai H , Xu D , Tang W , 2020. Etiology and ophthalmic characteristics of infectious and infection-related optic neuropathies. Yan Ke Xue Bao 35: 327336.

    • Search Google Scholar
    • Export Citation
  • 20.

    Neuro-ophthalmology Group of Ophthalmology Branch of Chinese Medical Association , 2022. Chinese expert consensus on the diagnosis and treatment of infiltrative optic neuropathy (2022) [in Chinese]. Chin J Ocul Fundus Dis. 38: 955962.

    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 194 194 34
Full Text Views 1810 1810 0
PDF Downloads 177 177 0
 
Membership Banner
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save