Lewallen S, Taylor T E, Molyneux M E, Wills B A, Courtright P
International Eye Foundation, Blantyre, Malawi, Africa.
Ophthalmology. 1993 Jun;100(6):857-61. doi: 10.1016/s0161-6420(93)31563-0.
Cerebral malaria is a major cause of mortality and morbidity in children in tropical regions. The pathogenesis of this important complication of Plasmodium falciparum infection is not well understood. A number of observers have commented on the presence of retinal pathology in various types of malaria. Previous reports have not demonstrated that fundus findings are significantly associated with outcome.
The authors examined the ocular fundi, by direct and indirect ophthalmoscopy, of 56 children admitted consecutively with cerebral malaria.
Every child with a normal fundus on admission recovered fully, but two conditions were found to be associated with a poor outcome. Patients with papilledema had a relative risk of poor outcome 5.2 times greater than those without this finding (P < 0.01). Patients with retinal edema outside the posterior vascular arcades had a relative risk of poor outcome 3.9 times greater than those without this finding (P < 0.01). These two fundus findings were independently predictive of a poor outcome.
Fundus findings are useful as predictors of outcome in children with cerebral malaria. The authors' findings suggest that there may be two distinct mechanisms associated with poor outcome in these children.
脑型疟疾是热带地区儿童死亡和发病的主要原因。恶性疟原虫感染这一重要并发症的发病机制尚不清楚。许多观察者评论了各种类型疟疾中视网膜病变的存在。先前的报告并未表明眼底检查结果与预后有显著关联。
作者通过直接和间接检眼镜检查了56例因脑型疟疾连续入院的儿童的眼底。
入院时眼底正常的每个儿童均完全康复，但发现有两种情况与预后不良相关。视乳头水肿患者预后不良的相对风险比无此表现者高5.2倍（P<0.01）。后血管弓外视网膜水肿患者预后不良的相对风险比无此表现者高3.9倍（P<0.01）。这两种眼底表现可独立预测预后不良。
眼底检查结果可作为脑型疟疾患儿预后的预测指标。作者的研究结果表明，这些患儿预后不良可能存在两种不同的机制。
