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Published on: June 8, 2017
Retinopathy as a Prognostic Marker in Cerebral Malaria
Jyoti Singh1, Rakesh Verma, Anamika Tiwari
1Departments of Pediatrics and #Ophthalmology, SS Medical College, Rewa, MP; and *Department of Pediatrics, Maulana Azad Medical College, New Delhi. Correspondence to: Prof HP Singh, Department of Pediatrics, SS Medical College, Rewa, MP 426 001. drhpsingh1@rediffmail.com.
Insights
Malarial retinopathy, or fundal changes, significantly increases mortality risk in children with cerebral malaria. This finding aids in prognostication and resource allocation for intensive care.
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Background:
- Cerebral malaria is a severe complication of malaria, particularly in children.
- Malarial retinopathy, characterized by fundal changes, is a known complication.
- The prognostic significance of malarial retinopathy in pediatric cerebral malaria requires further elucidation.
Purpose of the Study:
- To investigate the association between malarial retinopathy and mortality in children diagnosed with cerebral malaria.
- To determine if specific fundal changes correlate with increased mortality risk.
Main Methods:
- A cohort of 50 children with cerebral malaria were evaluated for retinopathy by a single ophthalmologist.
- Data on retinopathy presence and specific fundal changes were collected.
- Mortality during hospital stay was recorded and analyzed in relation to retinopathy.
Main Results:
- Malarial retinopathy was observed in 48% of the children studied.
- A significant association was found between the presence of any retinopathy and increased mortality risk (P=0.02).
- Specific findings like papilledema, hemorrhages, and vessel changes were also significantly linked to higher mortality.
Conclusions:
- Malarial retinopathy is a significant predictor of mortality in pediatric cerebral malaria.
- Ophthalmological findings can aid in prognostication and triaging for intensive care.
- Early detection of retinopathy may improve patient outcomes.
Objective:
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.
Conclusion:
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.
