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Retinal haemorrhage in cerebral malaria
P E Olumese1, A A Adeyemo, R A Gbadegesin
1Department of Clinical Pharmacology, College of Medicine, University College Hospital, Ibadan, Nigeria.
Insights
Retinal hemorrhages in children with cerebral malaria indicate a poor prognosis. Fundoscopic exams help assess severity and predict outcomes in pediatric cerebral malaria cases.
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Background:
- Cerebral malaria is a severe complication of Plasmodium falciparum infection in children.
- Fundoscopic examination is crucial for diagnosing and managing neurological complications.
Purpose of the Study:
- To investigate the prevalence of fundoscopic abnormalities in children with cerebral malaria.
- To determine the association between fundoscopic findings and mortality in pediatric cerebral malaria.
Main Methods:
- A study was conducted on 73 children diagnosed with cerebral malaria.
- Fundoscopic examinations were performed to identify normal findings, papilledema, and retinal hemorrhages.
- Statistical analysis, including chi-squared tests and odds ratios, was used to assess associations with mortality.
Main Results:
- 52.1% had normal fundi, 24.7% papilledema, and 23.3% retinal hemorrhages.
- Mortality rates were higher in groups with papilledema (22%) and retinal hemorrhages (47%) compared to normal fundi (16%).
- Retinal hemorrhages were significantly associated with increased mortality (adjusted Odds Ratio = 4.6).
Conclusions:
- Fundoscopic abnormalities are common in pediatric cerebral malaria.
- Retinal hemorrhages are a significant predictor of poor prognosis and mortality.
- Fundoscopy aids in assessing intracranial pressure and predicting outcomes in cerebral malaria.
Abstract:
We examined the fundi of 73 children aged between six months and six years with confirmed diagnosis of cerebral malaria at the Children's Emergency Ward of the University College Hospital, Ibadan. Normal fundi, papilloedema and retinal haemorrhages were present in 38(52.1%), 18(24.7%) and 17(23.3%), respectively on admission. There were no significant differences between the three groups with respect to age, sex, admission coma score, posture, packed cell volume, parasite density, serum glucose, and serum electrolyte profile on admission. The mortality rates were 16%, 22% and 47% in the normal, papilloedema and retinal haemorrhage groups, respectively (Chi-squared for linear trend = 5.587, p = 0.018). Retinal haemorrhage was significantly associated with death (chi 2 = 5.846, p = 0.0192; Crude Odds ratio = 4.1, 95% CI = 1.1, 15.6; p = 0.018). The association was still present after adjusting for other known risk factors for mortality, including age, sex, acidosis, parasite density, anaemia, deep coma, and hypoglycaemia (adjusted Odds Ratio = 4.6, p = 0.0688). Papilloedema alone was not associated with mortality when compared with normal fundi [Fischer's exact (p = 0.448)]. It is concluded that fundoscopic abnormalities are common in children with cerebral malaria, and that retinal haemorrhage is associated with a poor prognosis in such children with cerebral malaria. Therefore, fundoscopic examination is not only useful to rule out raised intracranial pressure before performing a lumbar puncture, but also a useful measure in assessing prognosis in children suffering from cerebral malaria.