Kilimanjaro Centre for Community Ophthalmology, KCM College, Tumaini University, Moshi, Tanzania.
Future Microbiol. 2011 Mar;6(3):349-55. doi: 10.2217/fmb.11.3.
Accurate diagnosis of cerebral malaria (CM) is important for patient management, epidemiological and end point surveillance, and enrolling patients with CM in studies of pathogenesis or therapeutic trials. In malaria-endemic areas, where asymptomatic Plasmodium falciparum parasitemia is common, a positive blood film in a comatose individual does not prove that the coma is due to malaria. A retinopathy consisting of two unique features - patchy retinal whitening and focal changes of vessel color - is highly specific for encephalopathy of malarial etiology. White-centered retinal hemorrhages are a common but less specific feature. Either indirect or direct ophthalmoscopy can be used to identify the changes, and both procedures can be learned and practiced by nonspecialist clinicians. In view of its important contributions to both clinical care and research, examination of the retina should become a routine component of the assessment of a comatose child or adult when CM is a possible diagnosis.
准确诊断脑型疟疾（CM）对于患者管理、流行病学和终点监测以及将患有 CM 的患者纳入 CM 发病机制或治疗试验的研究非常重要。在疟疾流行地区，无症状疟原虫寄生虫血症很常见，昏迷个体的阳性血片并不能证明昏迷是由疟疾引起的。一种由两个独特特征组成的视网膜病变——斑片状视网膜白化和血管颜色的局灶性变化——高度提示疟原虫病因引起的脑病。以白色为中心的视网膜出血是一种常见但特异性较低的特征。间接或直接检眼镜均可用于识别这些变化，并且非专业临床医生可以学习和实践这两种程序。鉴于其对临床护理和研究的重要贡献，当 CM 可能是诊断时，对昏迷的儿童或成人进行视网膜检查应成为评估的常规组成部分。
