Olumese P E, Adeyemo A A, Gbadegesin R A, Walker O
Department of Clinical Pharmacology, College of Medicine, University College Hospital, Ibadan, Nigeria.
East Afr Med J. 1997 May;74(5):285-7.
We examined the fundi of 73 children aged between six months and six years with confirmed diagnosis of cerebral malaria at the Children's Emergency Ward of the University College Hospital, Ibadan. Normal fundi, papilloedema and retinal haemorrhages were present in 38(52.1%), 18(24.7%) and 17(23.3%), respectively on admission. There were no significant differences between the three groups with respect to age, sex, admission coma score, posture, packed cell volume, parasite density, serum glucose, and serum electrolyte profile on admission. The mortality rates were 16%, 22% and 47% in the normal, papilloedema and retinal haemorrhage groups, respectively (Chi-squared for linear trend = 5.587, p = 0.018). Retinal haemorrhage was significantly associated with death (chi 2 = 5.846, p = 0.0192; Crude Odds ratio = 4.1, 95% CI = 1.1, 15.6; p = 0.018). The association was still present after adjusting for other known risk factors for mortality, including age, sex, acidosis, parasite density, anaemia, deep coma, and hypoglycaemia (adjusted Odds Ratio = 4.6, p = 0.0688). Papilloedema alone was not associated with mortality when compared with normal fundi [Fischer's exact (p = 0.448)]. It is concluded that fundoscopic abnormalities are common in children with cerebral malaria, and that retinal haemorrhage is associated with a poor prognosis in such children with cerebral malaria. Therefore, fundoscopic examination is not only useful to rule out raised intracranial pressure before performing a lumbar puncture, but also a useful measure in assessing prognosis in children suffering from cerebral malaria.
我们在伊巴丹大学学院医院儿童急诊病房，对73名年龄在6个月至6岁之间、确诊为脑型疟疾的儿童进行了眼底检查。入院时，眼底正常、视乳头水肿和视网膜出血的患儿分别有38例（52.1%）、18例（24.7%）和17例（23.3%）。三组在年龄、性别、入院时昏迷评分、姿势、红细胞压积、寄生虫密度、血糖以及血清电解质方面无显著差异。正常、视乳头水肿和视网膜出血组的死亡率分别为16%、22%和47%（线性趋势卡方检验=5.587，p=0.018）。视网膜出血与死亡显著相关（卡方=5.846，p=0.0192；粗比值比=4.1，95%可信区间=1.1，15.6；p=0.018）。在对包括年龄、性别、酸中毒、寄生虫密度、贫血、深度昏迷和低血糖等其他已知死亡危险因素进行校正后，这种关联仍然存在（校正比值比=4.6，p=0.0688）。与眼底正常的患儿相比，单纯视乳头水肿与死亡率无关[费舍尔精确检验（p=0.448）]。结论是，眼底镜检查异常在脑型疟疾患儿中很常见，视网膜出血与这类脑型疟疾患儿的预后不良相关。因此，眼底镜检查不仅有助于在进行腰椎穿刺前排除颅内压升高，也是评估脑型疟疾患儿预后的一项有用措施。
