Retinal findings in children with severe forms of malaria appear related to disease outcomes such as prolonged coma and death

Aug 10 2004

Retinal findings in children with severe forms of malaria (with brain involvement and severe anemia) appear related to disease outcomes such as prolonged coma and death, according to an article in the August issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.

Malaria is a disease caused by infection with one or more of four different protozoans and marked by recurring fevers, prostration, and sometimes death. The protozoa are spread from one infected person to another by the bite of Anopheles mosquitoes and, rarely, via blood transfusion.

According to the article, severe forms of malaria due to the parasite Plasmodium falciparum, still have high rates of death and disability (including coma) in sub-Saharan Africa, and cause 1.5 to 2.7 million deaths each year, mostly in African children with cerebral malaria (CM) or severe malarial anemia (SMA). Severe malaria is also associated with retinal disorders (retinopathy) which have been found in 77 percent of patients with CM, according to the article.

Nicholas A. Beare, F.R.C.Ophth., of Royal Liverpool University Hospital, England, and colleagues studied 326 children admitted to a central African hospital and treated for CM or SMA during two consecutive malaria seasons. The researchers investigated possible associations between the presence and severity of retinal signs and clinical outcomes in the children.

Of the 326 children, 278 had CM, and of those, 170 (61 percent) had retinopathy. Twenty-five of 47 children with SMA had retinopathy. For children with CM, retinopathy was associated with higher death rates, and more severe retinal signs were associated with increasing risk of death and prolonged time to recover consciousness from a comatose state.

"In childhood CM, severity of retinopathy is related to prolonged coma and death," the researchers write. "Our results support the hypothesis that retinal signs in CM are related to cerebral pathophysiology [disease]."