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    www.ophthalmos.co.uk. Accessed April 12, 2006.

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MALARIAL RETINOPATHY: A NEWLY ESTABLISHED DIAGNOSTIC SIGN IN SEVERE MALARIA

NICHOLAS A. V. BEAREMalawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi; St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Blantyre Malaria Project, Queen Elizabeth Central Hospital, Blantyre, Malawi; Kilimanjaro Centre for Community Ophthalmology, Kilimanjaro Christian Medical Centre Hospital/Tumaini University, Moshi, Tanzania

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TERRIE E. TAYLORMalawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi; St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Blantyre Malaria Project, Queen Elizabeth Central Hospital, Blantyre, Malawi; Kilimanjaro Centre for Community Ophthalmology, Kilimanjaro Christian Medical Centre Hospital/Tumaini University, Moshi, Tanzania

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SIMON P. HARDINGMalawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi; St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Blantyre Malaria Project, Queen Elizabeth Central Hospital, Blantyre, Malawi; Kilimanjaro Centre for Community Ophthalmology, Kilimanjaro Christian Medical Centre Hospital/Tumaini University, Moshi, Tanzania

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SUSAN LEWALLENMalawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi; St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Blantyre Malaria Project, Queen Elizabeth Central Hospital, Blantyre, Malawi; Kilimanjaro Centre for Community Ophthalmology, Kilimanjaro Christian Medical Centre Hospital/Tumaini University, Moshi, Tanzania

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MALCOLM E. MOLYNEUXMalawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre, Malawi; St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan; Blantyre Malaria Project, Queen Elizabeth Central Hospital, Blantyre, Malawi; Kilimanjaro Centre for Community Ophthalmology, Kilimanjaro Christian Medical Centre Hospital/Tumaini University, Moshi, Tanzania

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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.

Author Notes

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