Volume 82, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



The diagnosis of cerebral malaria (CM) is difficult to confirm in endemic regions with limited neurodiagnostics. Accurate diagnoses are critical for trials and outcomes studies. Findings from an autopsy-based study suggest that identifying malaria retinopathy in children satisfying the standard clinical case definition of CM improves our ability to accurately diagnose CM . In a analysis of a prospective exposure-control study to evaluate CM as a risk factor for epilepsy, we stratified children meeting the standard case definition by their retinopathy status (presence versus absence) and compared these groups for pre-existing risk factors for epilepsy. We also compared them to the concurrently enrolled, non-comatose controls. Children meeting the standard case definition of CM who lacked malaria retinopathy had a higher prevalence of pre-existing developmental problems and family history of epilepsy. This subset of patients may represent children with a pre-existing propensity to adverse neurologic symptoms and outcomes.


Article metrics loading...

Loading full text...

Full text loading...



  1. Brewster DR, Kwiatkowski D, White NJ, , 1990. Neurological sequelae of cerebral malaria in children. Lancet 336: 10391043.[Crossref]
  2. Molyneux ME, Taylor TE, Wirima JJ, Borgstein A, , 1989. Clinical features and prognostic indicators in paediatric cerebral malaria: a study of 131 comatose Malawian children. Quarterly Journal of Medicine 71: 441459.
  3. WHO, 1999. SEAR malaria incidence. WHO. Available at: http://www.rollbackmalaria.org/docs/burden.htm.
  4. Taylor TE, Fu WJ, Carr RA, Whitten RO, Mueller JS, Fosiko NG, Lewallen S, Liomba NG, Molyneux ME, , 2004. Differentiating the pathologies of cerebral malaria by postmortem parasite counts. Nat Med 10: 143145.[Crossref]
  5. Bronzan RN, McMorrow ML, Kachur SP, , 2008. Diagnosis of malaria: challenges for clinicians in endemic and non-endemic regions. Journal of Molecular Diagnostics 12: 299306.
  6. Dal-Bianco MP, Koster KB, Kombila UD, Kun JF, Grobusch MP, Ngoma GM, Matsiegui PB, Supan C, Salazar CL, Missinou MA, Issifou S, Lell B, Kremsner P, , 2007. High prevalence of asymptomatic Plasmodium falciparum infection in Gabonese adults. Am J Trop Med Hyg 77: 939942.
  7. Smith T, Schellenberg JA, Hayes R, , 1994. Attributable fraction estimates and case definitions for malaria in endemic areas. Stat Med 13: 23452358.[Crossref]
  8. Carter JA, Neville BG, White S, Ross AJ, Otieno G, Mturi N, Musumba C, Newton CR, , 2004. Increased prevalence of epilepsy associated with severe falciparum malaria in children. Epilepsia 45: 978981.[Crossref]
  9. Newton CR, Warrell DA, , 1998. Neurological manifestations of falciparum malaria. Ann Neurol 43: 695702.[Crossref]
  10. Lewallen S, Harding SP, Ajewole J, Schulenburg WE, Molyneux ME, Marsh K, Usen S, White NJ, Taylor TE, , 1999. A review of the spectrum of clinical ocular fundus findings in P. falciparum malaria in African children with a proposed classification and grading system. Trans R Soc Trop Med Hyg 93: 619622.[Crossref]
  11. Lewallen S, White VA, Whitten RO, Gardiner J, Hoar B, Lindley J, Lochhead J, McCormick A, Wade K, Tembo M, Mwenechanyana J, Molyneux ME, Taylor TE, , 2000. Clinical-histopathological correlation of the abnormal retinal vessels in cerebral malaria. Arch Ophthalmol 118: 924928.
  12. Lewallen S, Bronzan RN, Beare NA, Harding SP, Molyneux ME, Taylor TE, , 2008. Using malarial retinopathy to improve the classification of children with cerebral malaria. Trans R Soc Trop Med Hyg 102: 10891094.[Crossref]
  13. Beare NA, Harding SP, Taylor TE, Lewallen S, Molyneux ME, , 2009. Perfusion abnormalities in children with cerebral malaria and malarial retinopathy. J Infect Dis 199: 263271.[Crossref]
  14. Beare NA, Taylor TE, Harding SP, Lewallen S, Molyneux ME, , 2006. Malarial retinopathy: a newly established diagnostic sign in severe malaria. Am J Trop Med Hyg 75: 790797.
  15. Placencia M, Sander JW, Shorvon SD, Ellison RH, Cascante SM, , 1992. Validation of a screening questionnaire for the detection of epileptic seizures in epidemiological studies. Brain 115: 783794.[Crossref]
  16. Durkin MS, Hasan ZM, Hasan KZ, , 1995. The ten questions screen for childhood disabilities: its uses and limitations in Pakistan. J Epidemiol Community Health 49: 431436.[Crossref]
  17. Durkin MS, Wang W, Shrout PE, Zaman SS, Hasan ZM, Desai P, Davidson LL, , 1995. Evaluating a ten questions screen for childhood disability: reliability and internal structure in different cultures. J Clin Epidemiol 48: 657666.[Crossref]
  18. Berg AT, , 1992. Febrile seizures and epilepsy: the contributions of epidemiology. Paediatr Perinat Epidemiol 6: 145152.[Crossref]
  19. Berg AT, Shinnar S, , 1991. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology 41: 965972.[Crossref]
  20. Berg AT, Shinnar S, , 1996. Unprovoked seizures in children with febrile seizures: short-term outcome. Neurology 47: 562568.[Crossref]

Data & Media loading...

  • Received : 09 Sep 2009
  • Accepted : 16 Nov 2009

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error