Retinopathy as a Prognostic Marker in Cerebral Malaria

Objectives: To study the association between fundal changes (malarial retinopathy) and mortality in children with cerebral malaria. Methods: 50 consecutive children (mean age 8.4 y, 23 males) with cerebral malaria (acute febrile encephalopathy and either peripheral smear or Rapid diagnostic test positive for malaria) were evaluated by a single ophthalmologist for any changes of retinopathy. Children were managed as per standard guidelines for treatment of cerebral malaria. Results: P. vivax infection was seen in one child, P. falciparum infection in 42 children, and a mixed infection in 7. Retinopathy was present in 48% of the children. 13 children died during hospital stay. The mean interval from admission to fundus examination was 11.6 (4.64) h. Presence of 'any retinopathy' (P=0.02), and either of papilledema (P=0.02), hemorrhages (P=0.005) or vessel changes (P=0.01), were associated with a significantly higher risk of death. Conclusions: Malarial retinopathy is significantly associated with mortality in children with cerebral malaria. It may be used for both prognostication, and triaging for optimum utilization of intensive care facilities in these children.