Neurologic outcomes in retinopathy-negative cerebral malaria survivors
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Abstract
Objectives: Patients surviving retinopathy-positive cerebral malaria (CM) are at high risk for the development of epilepsy, developmental disabilities, and behavioral abnormalities. We aimed to establish whether retinopathy-negative CM is also a risk factor for these outcomes.
Methods: Between 2005 and 2007, survivors of CM and concurrently hospitalized controls in Blantyre, Malawi, were followed to assess the development of neurologic abnormalities. At discharge and every 3 months thereafter, incident cases of epilepsy and developmental disabilities were ascertained using screening questionnaires and confirmatory neurologic examinations. Incident cases of epilepsy and developmental disabilities were compared in retinopathy-negative CM survivors to controls and retinopathy-positive CM survivors.
Results: Thirty-five retinopathy-negative CM survivors were enrolled. Their neurologic outcomes were compared to 132 retinopathy-positive CM survivors and 272 controls. Compared to survivors of retinopathy-positive CM, children without malaria retinopathy have an equal odds of adverse neurologic outcome (odds ratio [OR] = 1.0, 95% confidence interval [CI] 0.4–2.2). Eleven of 35 survivors of retinopathy-negative CM had at least 1 adverse neurologic outcome compared to 2 of 272 controls (OR 61.9, 95% CI 13.0–295.5). In retinopathy-negative CM survivors, a Blantyre Coma Scale score ≤1 on admission was associated with an adverse outcome.
Conclusions: Compared with controls, children surviving either retinopathy-negative or -positive CM are at similar high risk for adverse neurologic outcomes. Studies to evaluate preventive and therapeutic strategies in children with both retinopathy-negative and -positive CM are needed to improve mortality, morbidity, or both.
GLOSSARY
- CI=
- confidence interval;
- CM=
- cerebral malaria;
- OR=
- odds ratio
Footnotes
Study funding: Supported by grants NIH/NINDS K23 NS046086-01 (G.L.B.), NIH/NIAID R01 AI034969-10AI (T.E.T.), and the Wellcome Trust 074125/Z/04/Z (M.E.M.).
Editorial, page 1196
- Received January 11, 2012.
- Accepted March 28, 2012.
- Copyright © 2012 by AAN Enterprises, Inc.
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Letters: Rapid online correspondence
- RETINOPATHY IN MALARIA-?PROGNOSTIC SIGNIFICANCE
- Khichar SHUBHAKARAN, Associate Professor Neurology, Dr. S. N. Medical College Jodhpurdrkhicharsk@gmail.com
Submitted October 01, 2012
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