Prognostic significance and course of retinopathy in children with severe malaria
Prognostic significance and course of retinopathy in children with severe malaria
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DOI：
10.1001/archopht.122.8.1141
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发表时间：
2004-08-01
影响因子：
--
通讯作者：
Harding, SP
中科院分区：
文献类型：
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作者：
Beare, NA;Southern, C;Harding, SP
目的：视网膜的发现，在儿童治疗严重疟疾的疾病结果，并确定在fundus.Methods的变化过程中：一项前瞻性研究的儿童脑型疟疾（CM）和严重的疟疾性贫血承认疟疾研究项目，布兰太尔，马拉维，在2个疟疾季节。间接和直接检眼镜检查入院和每天进行，受病人的cooperation.Results：三百二十六例（91%）与复杂的疟疾被招募。278例患者有CM，其中170例（61%）有一定程度的视网膜病变; 47例严重疟疾性贫血患者中有25例（53%）有视网膜病变。在CM中，视网膜病变与随后的死亡相关（相对风险，3.7; 95%置信区间，1.6-8.5），视乳头水肿的风险最高（相对风险，4.5; 95%置信区间，2.7-7.6）。视网膜体征严重程度的增加与致死性结局风险的增加相关（P <0.05），与视乳头水肿无关。在幸存者中，视网膜体征与意识恢复时间延长相关（P <0.001）。重度疟疾性贫血患者的预后较好，视网膜病变的严重程度低于CM患者。在116例CM患者中，在入院期间和出院后27例患者中进行了纵向随访。视网膜病变的大量增加与死亡相关（P = 0.02）。视网膜体征解决了超过1至4 wk，无视网膜severity.Conclusions：在儿童CM，视网膜病变的严重程度与长期昏迷和死亡有关。我们的研究结果支持这一假设，视网膜的迹象，在CM有关的脑病理生理。
Objectives: To relate retinal findings in children treated for severe malaria to disease outcome and to determine the course of changes in the fundus.Methods: A prospective study of children with cerebral malaria (CM) and severe malarial anemia admitted to the Malaria Research Project, Blantyre, Malawi, during 2 malaria seasons. Indirect and direct ophthalmoscopy were performed on admission and daily, subject to the patient's cooperation.Results: Three hundred twenty-six patients (91%) with complicated malaria were recruited. Two hundred seventy-eight patients had CM and of these 170 (61%) had some degree of retinopathy; 25 (53%) of 47 with severe malarial anemia had retinopathy. In CM, retinopathy was associated with subsequent death (relative risk, 3.7; 95% confidence interval, 1.6-8.5) and papilledema conferred the highest risk (relative risk, 4.5; 95% confidence interval, 2.7-7.6). Increasing severity of retinal signs was related to increasing risk of a fatal outcome (P < .05), independent of papilledema. In survivors, retinal signs were associated with prolonged time to recover consciousness (P < .001). Patients with severe malarial anemia had better outcomes and less severe retinopathy than those with CM. In 116 patients with CM, fundi were followed up longitudinally during admission and in 27 patients after hospital discharge. A large increase in retinal hemorrhages was associated with death (P = .02). Retinal signs resolved over I to 4 weeks without retinal sequelae.Conclusions: In childhood CM, severity of retinopathy is related to prolonged coma and death. Our results support the hypothesis that retinal signs in CM are related to cerebral pathophysiology.