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Published on: June 8, 2017
Using malarial retinopathy to improve the classification of children with cerebral malaria
Susan Lewallen1, Rachel N Bronzan, Nicholas A Beare
1Kilimanjaro Centre for Community Ophthalmology, Tumaini University/KCMC, Moshi, Tanzania. slewallen@kcco.net
Insights
Cerebral malaria (CM) deaths have unclear mechanisms. Ocular fundus findings in children with CM reveal distinct pathological processes and varying fatality rates, suggesting a need for improved diagnostic classification.
Area of Science:
- Malariology
- Pediatrics
- Ophthalmology
Background:
- Cerebral malaria (CM) is a severe complication of Plasmodium falciparum infection, often leading to death, but the precise mechanisms remain poorly understood.
- Ocular fundus examination can reveal specific signs of CM, such as malarial retinopathy and papilloedema, which may correlate with disease severity and outcomes.
Purpose of the Study:
- To compare clinical and laboratory data in children with CM based on ocular fundus findings.
- To investigate if different ocular findings in CM indicate distinct underlying pathological processes and prognoses.
Main Methods:
- A cohort of 880 children diagnosed with CM between 1999 and 2005 underwent ocular fundus examinations within 6 hours of admission.
- Children were categorized into three groups: normal fundus (N), malarial retinopathy (R), or papilloedema alone (P).
- Clinical and laboratory data, including blood pressure, breathing patterns, hematocrit, parasite density, and platelet count, were compared across the ocular subgroups.
Main Results:
- Case-fatality rates varied significantly among the groups: 44.4% in Group P, 18.0% in Group R, and 7.0% in Group N.
- Significant differences were observed in blood pressure, deep breathing prevalence, hematocrit, parasite density, and platelet concentration between the groups.
- Survivors in different groups also showed variations in the time taken to recover from coma.
Conclusions:
- Ocular fundus findings in children with CM are associated with different pathophysiological processes and clinical outcomes.
- The proposed classification based on ocular findings may improve diagnostic specificity and consistency in CM research.
- Further research utilizing this classification could enhance our understanding of CM pathogenesis and guide treatment strategies.
Abstract:
The mechanisms leading to death in cerebral malaria (CM) remain unclear. We compared clinical and laboratory data among children with CM, categorized by ocular fundus findings, to elucidate differences that suggest different underlying pathological processes. From 1999-2005, standard examinations, treatment and record keeping were used for children with a clinical diagnosis of CM. Children were divided into ocular subgroups: normal fundus (N), malarial retinopathy (R), or papilloedema alone (P) and appropriate statistical tests were used to compare clinical and laboratory findings among groups. Eight hundred and eighty children who had eye examinations within 6 h of admission were included in the analysis. The groups differed significantly in case-fatality rates: Group P, 44.4% (95% CI 25.3-63.2), Group R, 18.0% (95% CI 15.6-22.3) and Group N, 7.0% (95% CI 4.2-9.8). There were also significant differences among the groups in blood pressure, prevalence of deep breathing, haematocrit, parasite density, platelet concentration and, among survivors, hours taken to recover from coma. Differences among groups suggest that different underlying pathophysiological processes are operating in children with CM defined by existing criteria. Our proposed classification, by improving the specificity of diagnosis, would enhance consistency among different study sites and prove useful in future research studies.
