Abstract
Objectives
To study the association between fundal changes (malarial retinopathy) and mortality in children with cerebral malaria.
Methods
50 consecutive children (mean age 8.4 y, 23 males) with cerebral malaria (acute febrile encephalopathy and either peripheral smear or Rapid diagnostic test positive for malaria) were evaluated by a single ophthalmologist for any changes of retinopathy. Children were managed as per standard guidelines for treatment of cerebral malaria.
Results
P. vivax infection was seen in one child, P. falciparum infection in 42 children, and a mixed infection in 7. Retinopathy was present in 48% of the children. 13 children died during hospital stay. The mean interval from admission to fundus examination was 11.6 (4.64) h. Presence of ‘any retinopathy’ (P=0.02), and either of papilledema (P=0.02), hemorrhages (P=0.005) or vessel changes (P=0.01), were associated with a significantly higher risk of death.
Conclusions
Malarial retinopathy is significantly associated with mortality in children with cerebral malaria. It may be used for both prognostication, and triaging for optimum utilization of intensive care facilities in these children.
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References
Kochar DK, Shubhakaran, Kumawat BL, Thanvi I, Joshi WHAT THIS STUDY ADDS? • Malarial retinopathy is significantly associated with mortality in children with cerebral malaria in Central India. A, Vyas SP. Ophthalmoscopic abnormalities in adults with falciparum malaria. QJ Med. 1998;91:845–52.
Beare NA, Southern C, Chalira C, Taylor TE, Molyneux ME, Harding SP. Prognostic significance and course of retinopathy in children with severe malaria. Arch Ophthalmol. 2004;122:1141–7.
Jain V, Avinash C, Pradeep K, Manmohan S, Mrigendra P, Rasik B, et al. Burden of cerebral malaria in Central India (2004–2007). Am J Trop Med Hyg. 2008;79:636–42.
Singh J, Soni D, Mishra D, Singh HP, Bijesh S. Placental and neonatal outcome in maternal malaria: A prospective cohort study from Central India. Indian Pediatr. 2014;51:285–8.
Schemann J, Doumbo O, Malvy D, Traore L, Kone A, Sidibe T, et al. Ocular lesions associated with malaria in children in Mali. Am J Trop Med Hyg. 2002;67:61–3.
Birbeck G, Beare N, Lewallen S, Glover SJ, Molyneux ME, Kaplan PW, et al. Identification of malaria retinopathy improves the specificity of the clinical diagnosis of cerebral malaria: findings from cohort study. Am J Trop Med Hyg. 2010;82:231–4.
Looareesuwan S, Warrell D, White N, Chanthavanich P, Warrell M, Chantaratherakitti S, et al. Retinal hemorrhage, a common sign of prognostic significance in cerebral malaria. Am J Trop Med Hyg. 1983;32:911–5.
Molyneux M, Taylor T, Wirima J, Borgstein A. Clinical features and prognostic indicators in paediatric cerebral malaria: A study of 131 comatose Malawian children. QJ Med. 1989;71:441–59.
Allen S, O’Donnell A, Alexander N, Clegg J. Severe malaria in children in Papua New Guinea. QJM. 1996;89:779–88.
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Singh, J., Verma, R., Tiwari, A. et al. Retinopathy as a prognostic marker in cerebral malaria. Indian Pediatr 53, 315–317 (2016). https://doi.org/10.1007/s13312-016-0844-x
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DOI: https://doi.org/10.1007/s13312-016-0844-x