Malarial Retinopathy in Bangladeshi Adults

Abdullah Abu Sayeed,Richard J Maude,Arjen M Dondorp,M Abul Faiz,Mahtab Uddin Hasan,Noor Mohammed,M Gofranul Hoque

doi:10.4269/ajtmh.2011.10-0205

Abdullah Abu Sayeed, Richard J Maude + Show 5 more

Open Access

https://doi.org/10.4269/ajtmh.2011.10-0205

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Abstract

To establish if assessment of malarial retinopathy in adult malaria using ophthalmoscopy by non-ophthalmologists has clinical and prognostic significance, 210 Bangladeshi adults were assessed by both direct and indirect ophthalmoscopy; 20 of 20 healthy subjects and 20 of 20 patients with vivax malaria showed no retinal changes, whereas in patients with falciparum malaria, indirect ophthalmoscopy revealed malarial retinopathy (predominantly retinal hemorrhages) in 18 of 21 (86%) fatal, 31 of 75 (41%) cerebral, 16 of 64 (25%) non-cerebral but severe, and 1 of 31 (3%) uncomplicated cases. Direct ophthalmoscopy missed retinopathy in one of these cases and found fewer retinal hemorrhages (mean difference = 3.09; 95% confidence interval = 1.50–4.68; P < 0.0001). Severity of retinopathy increased with severity of disease (P for trend < 0.0001), and renal failure, acidosis, and moderate/severe retinopathy were independent predictors of mortality by both ophthalmoscopic techniques. Direct ophthalmoscopy by non-ophthalmologists is an important clinical tool to aid diagnosis and prognosis in adults with severe malaria, and indirect ophthalmoscopy by non-ophthalmologists, although more sensitive, provides minimal additional prognostic information.

Highlights

MATERIALS AND METHODSEvery year, more than 1 million people die of severe and cerebral malaria.[1]
Vessel discoloration and the pattern of retinal whitening are unique to and retinal hemorrhages are relatively specific for severe malaria, and they can be used for diagnostic purposes in high transmission areas in sub-Saharan Africa, where it is difficult to distinguish severe malaria from other causes of severe febrile illness presenting with incidental peripheral blood parasitaemia.[5]
This study showed that over one-third of adult patients with severe malaria have malarial retinopathy on admission when assessed by non-expert direct and indirect ophthalmoscopy

Summary

Introduction

MATERIALS AND METHODSEvery year, more than 1 million people die of severe and cerebral malaria.[1]. Blood parasite count as independent variables (model 1 in Table 7) identified renal failure, acidosis, and moderate/severe retinopathy by either direct or indirect ophthalmoscopy as independent predictors for death.

Results

Conclusion