| Prognostic significance and course of retinopathy in children with severe malaria. | |
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MedLine Citation:
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PMID: 15302654 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To relate retinal findings in children treated for severe malaria to disease outcome and to determine the course of changes in the fundus. METHODS: A prospective study of children with cerebral malaria (CM) and severe malarial anemia admitted to the Malaria Research Project, Blantyre, Malawi, during 2 malaria seasons. Indirect and direct ophthalmoscopy were performed on admission and daily, subject to the patient's cooperation. RESULTS: Three hundred twenty-six patients (91%) with complicated malaria were recruited. Two hundred seventy-eight patients had CM and of these 170 (61%) had some degree of retinopathy; 25 (53%) of 47 with severe malarial anemia had retinopathy. In CM, retinopathy was associated with subsequent death (relative risk, 3.7; 95% confidence interval, 1.6-8.5) and papilledema conferred the highest risk (relative risk, 4.5; 95% confidence interval, 2.7-7.6). Increasing severity of retinal signs was related to increasing risk of a fatal outcome (P<.05), independent of papilledema. In survivors, retinal signs were associated with prolonged time to recover consciousness (P<.001). Patients with severe malarial anemia had better outcomes and less severe retinopathy than those with CM. In 116 patients with CM, fundi were followed up longitudinally during admission and in 27 patients after hospital discharge. A large increase in retinal hemorrhages was associated with death (P =.02). Retinal signs resolved over 1 to 4 weeks without retinal sequelae. CONCLUSIONS: In childhood CM, severity of retinopathy is related to prolonged coma and death. Our results support the hypothesis that retinal signs in CM are related to cerebral pathophysiology. |
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Authors:
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Nicholas A Beare; Caroline Southern; Chipo Chalira; Terrie E Taylor; Malcolm E Molyneux; Simon P Harding |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Archives of ophthalmology Volume: 122 ISSN: 0003-9950 ISO Abbreviation: Arch. Ophthalmol. Publication Date: 2004 Aug |
Date Detail:
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Created Date: 2004-08-10 Completed Date: 2004-08-17 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7706534 Medline TA: Arch Ophthalmol Country: United States |
Other Details:
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Languages: eng Pagination: 1141-7 Citation Subset: AIM; IM |
Affiliation:
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St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, England. nbeare@btinternet.com |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Analgesics, Non-Narcotic / therapeutic use Anemia / physiopathology Anticonvulsants / therapeutic use Antimalarials / therapeutic use Child Child, Preschool Coma / physiopathology Eye Infections, Parasitic / drug therapy, parasitology, physiopathology* Female Fluid Therapy Humans Infant Malaria, Cerebral / drug therapy, parasitology, physiopathology* Male Ophthalmoscopy Parasitemia / drug therapy, parasitology, physiopathology* Prognosis Prospective Studies Quinine / therapeutic use Retina / pathology Retinal Diseases / drug therapy, parasitology, physiopathology* |
| Chemical | |
Reg. No./Substance:
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0/Analgesics, Non-Narcotic; 0/Anticonvulsants; 0/Antimalarials; 130-95-0/Quinine |
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