Nasir Uddin Mahmud
Chittagong Medical College, Bangladesh
Title: Retinal changes in severe malaria in Bangladeshi children
Biography
Biography: Nasir Uddin Mahmud
Abstract
Introduction: A retinopathy specific to severe malaria has been reported in African and Malawi children and in Bangladeshi adults. Detection of this retinopathy can be a useful diagnostic tool. This study was designed to detect retinopathy in severe malaria cases in Bangladeshi children. Methods and subject: A prospective observational study was conducted including consecutive 190 severe malaria patients, aged 6 months to 12 years, admitted to Department of Pediatrics, Chittagong Medical College Hospital, Bangladesh, from April 2008 to March 2009. Eighty patients were cerebral malaria and 50 were severe non-cerebral malaria; 31 meningitis and 29 critically anemic patients were included as control. Direct and indirect ophthalmoscopy was performed by two independent observers. Results: Retinopathy was detected in 61.2% with cerebral malaria and in 48% with severe non-cerebral malaria patients. Retinal haemorrhage was detected in 46.2% and 43.4% of cerebral malaria and 32% and 24% of non-cerebral severe malaria and vascular changes were found in 33.8% and 7.2% of cerebral malaria and in 26% and 2% of non-cerebral severe malaria by indirect and direct ophthalmoscopy respectively. Papilloedema in 13.8% and 6% and peripheral whitening in 41.2% and 34% of cerebral and non-cerebral malaria respectively was detected. Macular whitening was found in 46.2% patients. Death was significantly higher in patients with retinopathy (p<0.001). Blantyre coma score (BCS) on admission was lower and hospital stay and coma recovery time was significantly longer in patients with retinopathy. Conclusion: Malarial retinopathy is an important diagnostic tool for diagnosis and is related to prognosis of patients with severe malaria. Key wards: severe malaria, retinopathy, children, Bangladesh