title: Clinical Comparison of Retinopathy-Positive and Retinopathy-Negative Cerebral Malaria.
abstract: AbstractCerebral malaria (CM) is a severe and often lethal complication of falciparum malaria. A classic malaria retinopathy is seen in some (retinopathy-positive [RP]) children but not others (retinopathy-negative [RN]), and is associated with increased parasite sequestration. It is unclear whether RN CM is a severe nonmalarial illness with incidental parasitemia or a less severe form of the same malarial illness as RP CM. Understanding the clinical differences between RP and RN CM may help shed light on the pathophysiology of malarial retinopathy. We compared clinical history, physical examination, laboratory findings, and outcomes of RP (N= 167) and RN (N= 87) children admitted to Mulago Hospital, Kampala, Uganda. Compared with RN children, RP children presented with a longer history of illness, as well as physical examination and laboratory findings indicative of more severe disease and organ damage. The hospital course of RP children was complicated by longer coma duration and a greater transfusion burden than RN children. Mortality did not differ significantly between RP and RN children (14.4% versus 8.0%,P= 0.14). Further, severity of retinal hemorrhage correlated with the majority of variables that differed between RP and RN children. The data suggest that RP and RN CM may reflect the spectrum of illness in CM, and that RN CM could be an earlier, less severe form of disease.
authors.affiliation: The Warren Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: Chandler
authors.initials: C
authors.lastname: Villaverde
authors.affiliation: Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Ruth
authors.initials: R
authors.lastname: Namazzi
authors.affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.|Department of Pediatrics, Indiana University, Indianapolis, Indiana.
authors.forename: Estela
authors.initials: E
authors.lastname: Shabani
authors.affiliation: Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Opoka
authors.affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.|Department of Pediatrics, Indiana University, Indianapolis, Indiana.
authors.forename: Chandy C
authors.initials: CC
authors.lastname: John
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003128:Coma / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D016779:Malaria, Cerebral / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D008297:Male; D010963:Plasmodium falciparum / Q000472:pathogenicity* / Q000502:physiology; D012162:Retinal Degeneration / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy; D012720:Severity of Illness Index; D013997:Time Factors; D014454:Uganda
chemical_list: D000962:Antimalarials