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Malarial Retinopathy in Bangladeshi Adults

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  • Chittagong Medical College Hospital, Chittagong, Bangladesh; Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, United Kingdom; Sir Salimullah Medical College, Mitford, Dhaka, Bangladesh

To establish if assessment of malarial retinopathy in adult malaria using ophthalmoscopy by non-ophthalmologists has clinical and prognostic significance, 210 Bangladeshi adults were assessed by both direct and indirect ophthalmoscopy; 20 of 20 healthy subjects and 20 of 20 patients with vivax malaria showed no retinal changes, whereas in patients with falciparum malaria, indirect ophthalmoscopy revealed malarial retinopathy (predominantly retinal hemorrhages) in 18 of 21 (86%) fatal, 31 of 75 (41%) cerebral, 16 of 64 (25%) non-cerebral but severe, and 1 of 31 (3%) uncomplicated cases. Direct ophthalmoscopy missed retinopathy in one of these cases and found fewer retinal hemorrhages (mean difference = 3.09; 95% confidence interval = 1.50–4.68; P < 0.0001). Severity of retinopathy increased with severity of disease (P for trend < 0.0001), and renal failure, acidosis, and moderate/severe retinopathy were independent predictors of mortality by both ophthalmoscopic techniques. Direct ophthalmoscopy by non-ophthalmologists is an important clinical tool to aid diagnosis and prognosis in adults with severe malaria, and indirect ophthalmoscopy by non-ophthalmologists, although more sensitive, provides minimal additional prognostic information.

Author Notes

*Address correspondence to Richard J. Maude, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand. E-mail: richardmaude@gmail.com

Financial support: This study was funded by the Malaria Research Group of Chittagong, Bangladesh. Mahidol–Oxford Tropical Medicine Research Unit is funded by the Wellcome Trust of Great Britain. R.J.M. is also funded by a British Council Fellowship.

Authors' addresses: Abdullah Abu Sayeed, Mahtab Uddin Hasan, Noor Mohammed, and M. Gofranul Hoque, Chittagong Medical College Hospital, Chittagong, Bangladesh, E-mails: abdullahdr25@yahoo.com, mahtabnipu@yahoo.com, mnoor99@ymail.com, and gofranul2006@yahoo.com. Richard J. Maude and Arjen M. Dondorp, Mahidol–Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mails: richardmaude@gmail.com and arjen@tropmedres.ac. M. Abul Faiz, Sir Salimullah Medical College, Mitford, Dhaka, Bangladesh, E-mail: drmafaiz@gmail.com.

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