Ocular fundal changes in children suffering from cerebral malaria

Area of Science:

• Ophthalmology
• Pediatric Infectious Diseases
• Malariology

Background:

• Cerebral malaria (CM) is a severe complication of Plasmodium falciparum infection in children.
• Ocular manifestations in CM can provide insights into disease severity and prognosis.
• Understanding the spectrum of retinal changes is vital for managing pediatric CM.

Purpose of the Study:

• To determine the frequency and distribution of retinal alterations in children diagnosed with cerebral malaria.
• To investigate the association between observed fundal changes and disease severity, visual prognosis, and patient survival.

Main Methods:

• An observational, cross-sectional study was conducted on 113 pediatric patients with CM in a tertiary care center.
• Comprehensive ophthalmological examinations were performed, and findings were correlated with clinical data on coma severity, recovery, and survival.
• Statistical analysis using SPSS software identified significant correlations (P < 0.05).

Main Results:

• Retinal changes were present in 68.14% of pediatric CM patients.
• The most frequent signs included white-centered hemorrhages and papilledema (53.09% each), followed by retinal whitening (51.33%) and vessel changes (39.82%).
• Significant correlations were found between white-centered retinal hemorrhages and visual prognosis (P=0.001), papilledema severity and parasite load (P=0.037), and retinal whitening and severe coma (P=0.002).

Conclusions:

• Retinal findings in pediatric cerebral malaria are linked to disease severity, characterized by high parasite loads.
• The presence of specific retinal signs is associated with poorer visual outcomes and increased mortality.
• All non-survivors exhibited at least four signs of malarial retinopathy, highlighting their prognostic value.