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Retinal findings predictive of outcome in cerebral malaria
S Lewallen1, H Bakker, T E Taylor
1International Eye Foundation, Blantyre, Malawi.
Abstract:
The pathogenesis of cerebral malaria is poorly understood. Direct and indirect ophthalmoscope examinations of 141 Malawian children with strictly defined cerebral malaria revealed 2 distinct and prognostically significant findings: papilloedema and extramacular retinal oedema. The relative risk of death in patients with papilloedema was 6.7 times that in patients without papilloedema. Extramacular retinal oedema was associated with a 2.9 fold increase in the relative risk of dying. The mortality rate in patients with neither of these signs was only 1.3% compared to an overall mortality rate of 9.2%. The clinical and laboratory features associated with each of these ophthalmological findings were different, suggesting that there may be at least 2 different pathogenetic processes in patients with cerebral malaria.
Insights
Ophthalmological findings in cerebral malaria, such as papilledema and retinal edema, indicate distinct disease processes and significantly impact mortality risk in children. These signs suggest varied paths to severe malaria.
Area of Science:
- Neurology
- Ophthalmology
- Infectious Diseases
Background:
- Cerebral malaria pathogenesis remains unclear.
- Ophthalmological signs may offer prognostic insights.
Purpose of the Study:
- To identify distinct ophthalmological findings in pediatric cerebral malaria.
- To assess the prognostic significance of these findings on mortality.
Main Methods:
- Direct and indirect ophthalmoscopy performed on 141 Malawian children with cerebral malaria.
- Correlation of ophthalmological findings with clinical and laboratory data and mortality rates.
Main Results:
- Papilledema identified as a significant predictor of mortality (RR 6.7).
- Extramacular retinal edema also associated with increased mortality risk (RR 2.9).
- Patients with neither sign had a low mortality rate (1.3%) versus overall (9.2%).
Conclusions:
- Papilledema and extramacular retinal edema are distinct, prognostically significant findings in cerebral malaria.
- These signs suggest at least two different pathogenetic pathways in pediatric cerebral malaria.
- Ophthalmological examination is crucial for risk stratification in cerebral malaria.