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Objectives:To relate retinal findi ngs in children treated for severe malaria to disease outcom e and to determine the course of changes in the fundus.Meth ods:A prospective study of children with cerebral mala ria(CM)and severe malarial anemia admitted to the Mala ria Research Project,Blantyre,Malawi,during 2malaria s easons.Indirect and direct ophthalmoscopy were perform ed on admission and daily,subject to the patients coop eration.Results:Three hundred twenty six patients(91%)with complicated malaria were recruited.Two hundred seventy-eight pa-tients had CM and of these 170(61%)had some degree of retinopathy;25(53%)of 47with severe malarial anemia had retinopathy.In CM,retin opathy was associ-ated with subsequent death(relative risk,3.7;95%confidence interval,1.6-8.5)and papilledema con-ferred the highest risk(relative risk,4.5;95%confi-dence interval,2.7-7.6).Increasing severity of retinal signs was related to increasing risk of a fatal outcome (P<.05),independent of papilledema.In sur vivors,retinal signs were associated with p rolonged time to recover consciousness(P<.001).Patients with severe malarial anemia had better outcomes and less s evere retinopathy than those with CM.In 116patients wi th CM,fundi were followed up longitudinally during a dmission and in 27pa-tients after hospital discharge.A l arge increase in retinal hemorrhages was associated with dea th(P=.02).Reti-nal signs resolved over 1to 4weeks wi thout retinal se-quelae.Conclusions:In childhood C M,severity of retinopathy is related to prolonged coma and death.Our results support the hypothesis that retinal signs in CM are related to cerebral pathophysiolog y.
Objectives: To relate retinal findi ngs in children treated for severe malaria to disease outcom e and determine the course of changes in the fundus. Meth ods: A prospective study of children with cerebral mala ria (CM) and severe malarial anemia admitted to the Malaria Research Project, Blantyre, Malawi, during 2 malaria s easons. Direct and direct ophthalmoscopy were performed ed on admission and daily, subject to the patients coopration. Results: Three hundred twenty six patients (91%) with complicated malaria were recruited. Two hundred seventy-eight pa-tients had CM and of these 170 (61%) had some degree of retinopathy; 25 (53%) of 47 with severe malarial anemia had retinopathy.In CM, retin opathy was associ-ated with subsequent death ( relative risk, 3.7; 95% confidence interval, 1.6-8.5) and papilledema con-ferred the highest risk (relative risk, 4.5; 95% confi-dence interval, 2.7-7.6) .Increasing severity of retinal signs was related to increasing risk of a fatal outcome (P <.05), independent of papilledema.I n sur vivors, retinal signs were associated with p rolonged time to recover consciousness (p <.001). Patients with severe malarial anemia had better outcomes and less evere retinopathy than those with CM. 116 patients wi th CM, fundi were followed up longitudinally during a dmission and in 27 pa-tients after hospital discharge. Al l arge increase in retinal hemorrhages was associated with dea th (P = .02). Reti-nal signs resolved over 1 to 4 weeksek thout retinal se- quelae.Conclusions: In childhood CM, severity of retinopathy is related to prolonged coma and death.Our results support the hypothesis that retinal signs in CM are related to cerebral pathophysiology.