Ocular fundal changes in children suffering from cerebral malaria

Abstract

Purpose: To assess the frequency and distribution of retinal changes in children suffering from cerebral malaria (CM), study the correlation between fundal changes and severity of disease, visual outcome, and survival of patients. Methods: An observational, cross-sectional study was done on pediatric patients, suffering from CM in a tertiary care center in eastern India. A complete ophthalmological examination was done and findings were tabulated. Their hospital admission records were checked for severity of coma, recovery, and prognosis. Data were analyzed with SPSS software, and P value < 0.05 was considered statistically significant. Results: Total 113 children of age group 0–18 years (mean age 7.88 ± 0.56 years) were enrolled in the study. Seventy-seven children (68.14%) had retinal changes. Most common retinal signs associated with malarial retinopathy were white centered hemorrhage and papilledema (53.09% each), followed by retinal whitening (51.33%) and vessel changes (39.82%). The correlation between the presence of white centered retinal hemorrhages and visual prognosis was found to be statistically significant (P = 0.001). Patients with Grade 4 parasitemia showed maximum retinal signs with a significant correlation between the severity of papilledema and parasite load (P = 0.037). Eighty-six patients (76.11%) survived and 27 patients (23.89%) died. All 27 patients who died showed all four signs of malarial retinopathy. Out of these, patients with retinal whitening suffered from severe coma, and this correlation was found to be statistically significant (P = 0.002). Conclusion: Presence of retinal signs in patients with CM is associated with severe disease (high parasite load), poor visual outcome, and increased mortality.

Keywords

• cerebral malaria
• glasgow coma scale
• parasitemia
• retinal whitening
• white centered hemorrhage