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Clues in the Eyes Can Stop the Misdiagnosis of Cerebral Malaria

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Photo: VisionQuest Biomedical

New technology could prevent widespread misdiagnosis of cerebral malaria in low-income countries, helping more children receive accurate diagnoses of life-threatening conditions, according to an American company that is developing a tool for this.

VisionQuest Biomedical Inc. told Devex that its tool, which is capable of diagnosing cerebral malaria via the retina, could be used in remote areas and places where there is a shortage of eye care professionals, and has plans to roll it out in African countries.

In regions across Africa where malaria is widespread, children who are rushed to health facilities in a coma are often misdiagnosed with cerebral malaria, a severe form of malaria that can cause brain damage, as well as seizures and coma. On the African continent, cerebral malaria primarily impacts children.

But one of the problems is that the symptoms of cerebral malaria overlap with other diseases and children can have the malaria parasite present in their blood with no symptoms. That means a blood test could give a positive result for malaria, even when that is not the primary cause of a child’s illness. In reality, they could be in a coma for other reasons, such as meningitis, which left untreated can be fatal or cause lasting neurological damage, experts said.

“Making an accurate diagnosis of cerebral malaria is a critical challenge,” said Sidney Ogolla, senior research officer at the Kenya Medical Research Institute.

An autopsy study in Malawi found that 25% of diagnoses of cerebral malaria were wrong, and the patient’s cause of death was something else. But there are clues in a patient’s eyes: Retinal abnormalities can help determine with high levels of accuracy if a patient has cerebral malaria.

Though such clues could significantly lower the number of misdiagnosed cases, challenges still exist in low-resource settings where having an ophthalmologist on-hand to do the screenings is rare. For example, in Tanzania, there is less than 1 ophthalmologist for every 1 million residents.

In response to this challenge, VisionQuest, which focuses on using artificial intelligence tools to detect diseases using the retina, is developing a portable and automated tool so these screenings can be carried out by someone with minimal training and in remote areas.

“These tools will allow us to make a better diagnosis to catch those children that may test positive for malaria, but that's not the main cause why they're in the hospital,” said Simon Barriga, chief executive officer at the company. “We potentially can save a lot of children from dying from an incorrect diagnosis.” 

Researchers are currently involved in clinical research studies using the software in three African countries to help strengthen the algorithm. The company said it plans to start registering it in Malawi, Kenya, Zambia, Rwanda, and Nigeria next year. It estimates that the product will be commercially available in those countries in 2022, with plans to roll it out in other countries following this.

Discovering Retinal Abnormalities

The research that identified these clues in the eyes began in the early 1990s, in Blantyre, Malawi, when two friends met for dinner. Dr. Susan Lewallen, an ophthalmologist, and Dr. Terrie Taylor, a doctor who coordinates a malaria research program, began to discuss the mysteries around the fast progression of cerebral malaria in the children Taylor was treating and the unknowns surrounding how the disease killed them.  

Lewallen asked Taylor if they had ever dilated the eyes of these children. The retina is, in some ways, an extension of the brain, and can give clues into what’s happening in the head. Taylor’s team hadn’t done this yet in detail.

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Schedule2 Oct 2023