Villaverde Chandler, Namazzi Ruth, Shabani Estela, Opoka Robert O, John Chandy C
The Warren Alpert Medical School, Brown University, Providence, Rhode Island.
Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
Am J Trop Med Hyg. 2017 May;96(5):1176-1184. doi: 10.4269/ajtmh.16-0315. Epub 2017 Jan 30.
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 ( = 167) and RN ( = 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%, = 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.
摘要
脑型疟疾（CM）是恶性疟原虫疟疾的一种严重且通常致命的并发症。在一些（视网膜病变阳性[RP]）儿童中可观察到典型的疟疾视网膜病变，而在其他儿童（视网膜病变阴性[RN]）中则未观察到，且其与寄生虫滞留增加有关。目前尚不清楚RN CM是一种伴有偶发寄生虫血症的严重非疟疾疾病，还是与RP CM相同疟疾疾病的一种较轻形式。了解RP和RN CM之间的临床差异可能有助于阐明疟疾视网膜病变的病理生理学。我们比较了乌干达坎帕拉穆拉戈医院收治的RP（n = 167）和RN（n = 87）儿童的临床病史、体格检查、实验室检查结果及预后。与RN儿童相比，RP儿童的病程更长，体格检查和实验室检查结果表明疾病和器官损伤更严重。RP儿童的住院病程因昏迷持续时间更长和输血负担比RN儿童更大而更为复杂。RP和RN儿童的死亡率无显著差异（14.4%对8.0%，P = 0.14）。此外，视网膜出血的严重程度与RP和RN儿童之间存在差异的大多数变量相关。数据表明，RP和RN CM可能反映了CM疾病的范围，且RN CM可能是疾病的一种早期、较轻形式。
