Neurologic outcomes in retinopathy-negative cerebral malaria survivors.
OBJECTIVE
Patients surviving retinopathy-positive cerebral malaria (CM) are at high risk for the development of epilepsy, developmental disabilities, and behavioral abnormalities. We aimed to establish whether retinopathy-negative CM is also a risk factor for these outcomes.


METHODS
Between 2005 and 2007, survivors of CM and concurrently hospitalized controls in Blantyre, Malawi, were followed to assess the development of neurologic abnormalities. At discharge and every 3 months thereafter, incident cases of epilepsy and developmental disabilities were ascertained using screening questionnaires and confirmatory neurologic examinations. Incident cases of epilepsy and developmental disabilities were compared in retinopathy-negative CM survivors to controls and retinopathy-positive CM survivors.


RESULTS
Thirty-five retinopathy-negative CM survivors were enrolled. Their neurologic outcomes were compared to 132 retinopathy-positive CM survivors and 272 controls. Compared to survivors of retinopathy-positive CM, children without malaria retinopathy have an equal odds of adverse neurologic outcome (odds ratio [OR] = 1.0, 95% confidence interval [CI] 0.4-2.2). Eleven of 35 survivors of retinopathy-negative CM had at least 1 adverse neurologic outcome compared to 2 of 272 controls (OR 61.9, 95% CI 13.0-295.5). In retinopathy-negative CM survivors, a Blantyre Coma Scale score ≤ 1 on admission was associated with an adverse outcome.


CONCLUSIONS
Compared with controls, children surviving either retinopathy-negative or -positive CM are at similar high risk for adverse neurologic outcomes. Studies to evaluate preventive and therapeutic strategies in children with both retinopathy-negative and -positive CM are needed to improve mortality, morbidity, or both.
International Neurologic and Psychiatric Epidemiology Program, Michigan State University, East Lansing, Michigan, USA. douglas.postels@ht.msu.edu
Douglas G
DG
Postels
Terrie E
TE
Taylor
Malcolm
M
Molyneux
Kara
K
Mannor
Peter W
PW
Kaplan
Karl B
KB
Seydel
Yamikani F
YF
Chimalizeni
Kondwani
K
Kawaza
Gretchen L
GL
Birbeck
D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016779:Malaria, Cerebral / Q000150:complications*; D008295:Malawi; D008297:Male; D010963:Plasmodium falciparum; D011379:Prognosis; D011446:Prospective Studies; D012164:Retinal Diseases / Q000209:etiology*; D012307:Risk Factors; D017741:Survivors