title: Malarial retinopathy in Bangladeshi adults.
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.
authors.affiliation: Chittagong Medical College Hospital, Chittagong, Bangladesh. abdullahdr25@yahoo.com
authors.forename: Abdullah
authors.initials: A
authors.lastname: Abu Sayeed
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Maude
authors.forename: Mahtab Uddin
authors.initials: MU
authors.lastname: Hasan
authors.forename: Noor
authors.initials: N
authors.lastname: Mohammed
authors.forename: M Gofranul
authors.initials: MG
authors.lastname: Hoque
authors.forename: Arjen M
authors.initials: AM
authors.lastname: Dondorp
authors.forename: M Abul
authors.initials: MA
authors.lastname: Faiz
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D001459:Bangladesh / Q000453:epidemiology; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D016780:Malaria, Vivax / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D009887:Ophthalmoscopy / Q000379:methods; D011379:Prognosis; D012164:Retinal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*
chemical_list: D000962:Antimalarials