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MALARIAL RETINOPATHY: A NEWLY ESTABLISHED DIAGNOSTIC SIGN IN SEVERE MALARIA

Severe malaria is commonly misdiagnosed in Africa, leading to a failure to treat other life-threatening illnesses. In malaria-endemic areas, parasitemia does not ensure a diagnosis of severe malaria because parasitemia can be incidental to other concurrent disease. The detection of malarial retinopathy is a candidate diagnostic test for cerebral malaria. Malarial retinopathy consists of a set of retinal abnormalities that is unique to severe malaria and common in children with cerebral malaria. Its presence and severity are related to risk of death and length of coma in survivors. A large, prospective autopsy study of children dying with cerebral malaria in Malawi found that malarial retinopathy was better than any other clinical or laboratory feature in distinguishing malarial from non-malarial coma. However, visualization has to date relied on specialist examination techniques. Further studies are planned to evaluate the usefulness of funduscopy by general clinicians in a variety of settings across Africa. Studies of the retina and retinal blood vessels provide an unparalleled opportunity to visualize an infected microvasculature and its effect on neural tissue in vivo. This report reviews current knowledge of malarial retinopathy, including its use as a diagnostic test in the comatose child, and its value as a tool for research into the pathophysiology of cerebral malaria.

Received February 17, 2006. Accepted for publication May 7, 2006.

Financial support: Nicholas A. V. Beare is supported by a Wellcome Trust project grant 074125/Z/04/Z. Malcolm E. Molyneux is supported by the Wellcome Trust grant 074124. Terrie E. Taylor is supported by the National Institutes of Health grant no. RO1 AI34969. The American Committee on Clinical Tropical Medicine and Travellers’ Health (ACCTMTH) assisted with publication expenses.

Disclosure: The Wellcome Trust and the National Institutes of Health NIH, while providing financial support, played no direct part in the preparation, review, or approval of this article. There are no competing financial interests.

^* Address correspondence to Nicholas A. V. Beare, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, PO Box 30096, Blantyre, Malawi. E-mail: nbeare{at}btinternet.com

Authors’ addresses: Nicholas A. V. Beare and Malcolm E. Molyneux, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, PO Box 30096, Blantyre, Malawi, E-mail: nbeare{at}btinternet.com. Terrie E. Taylor, Department of Internal Medicine, Michigan State University, East Lancing, MI 48824. Simon P. Harding, St. Paul’s Eye Unit, Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom. Susan Lewallen, Kilimanjaro Centre for Community Ophthalmology, Kilimanjaro Christian Medical Centre Hospital/Tumaini University, PO Box 2254, Moshi, Tanzania.

Reprint requests: Nicholas A. V. Beare, Malawi-Liverpool-Wellcome Clinical Research Programme, PO Box 30096, Blantyre 3, Malawi.

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