Title: To Study the Incidence of Papilledema with Relation to Outcome in Children with Cerebral and Non-Cerebral Malaria
Authors: Dr Puneet Agrawal, Dr Jyoti Singh, Dr Sujata Lakhtakia
DOI: https://dx.doi.org/10.18535/jmscr/v6i2.182
Abstract
Objective: To study the incidence of Papilledema with relation to outcome in children with Cerebral and Non-cerebral malaria
Design: Prospective, observational, cohort study, comprising of all malaria positive patients.
Setting: Department of Pediatrics, S.S.M.C and associated G.M. Hospital Rewa, Madhya Pradesh during the period of 1st August 2015 to 31st July 2016.
Participants: 100 consecutive patients with cerebral malaria and 100 patients with non-cerebral malaria were included in the study. All 200 cases were malaria positive. All children were evaluated by ophthalmologist for changes of retinopathy
Main Outcome Measure(s): Retinopathic changes and its correlation with mortality and duration of hospitalisation.
Results: In our study papilledema was seen in 25% and 6% of cases in CM and non-CM groups respectively. Mortality was 56% and 17% in patient having papilledema in CM and non-CM groups respectively. Mortality was significantly associated with papilledema in CM group.
Conclusions: In our study mortality was 56% and 17% in patient having papilledema in CM and non-CM groups respectively..This shows that in Cerebral malaria group a very high mortality was present in patients who had papilledema. Mortality was significantly associated with papilledema in CM group suggesting that patients having papilledema are at increased risk of dying.Therefore presence of papilledema in malaria can be used as a marker of serious disease and as an indication for intensive management of these cases.
Keywords: Malaria, Cerebral Malaria, Papilledema,Mortality.
References
- Snow RW, Newton CRJC, Craig MH &Steketee RW. The public health burden of plasmodium falciparum malaria in Africa: deriving the numbers. Disease Control Priorities Project Working 2003, Paper No. 11. Bethesda, Md.
- Jain V, Avinash C, Pradeep K, Manmohan S, Mrigendra P, Rasik B, et al. Burden of cerebral malaria in Central India (2004–2007). Am J Trop Med Hyg. 2008;79: 63642.
- Singh J, Soni D, Mishra D, Singh HP, Bijesh S. Placental and neonatal outcome in maternal malaria: A prospective cohort study from Central India. Indian Pediatr. 2014;51:2858.
- Kochar DK, Shubhakaran, Kumawat BL, Thanvi I, Joshi A, Vyas SP. Ophthalmoscopic abnormalities in adults withfalciparum malaria. QJ Med. 1998;91:84552.
- Poncet 1878. De La Retino-Coroidiste Palustre. Ann D‘oculistique. 1878; 79:201–218.
- Hero M, Harding SP, Riva CE, Winstanley PA, Peshu N, Marsh K. Photographic and angiographic characterization of the retina of Kenyan children with severe malaria. Arch Ophthalmol 1997;115: 997–1003
- Beare NAV, Taylor TE, Harding SP, Lewallen S, Molyneux ME. Malarial retinopathy: a newly established diagnostic sign in severe malaria. Am J Trop Med Hyg 2006 75 790-797.
- who.int /malaria
- Beare NAV, Taylor TE, Harding SP, Lewallen S, Molyneux ME. Malarial retinopathy: a newly established diagnostic sign in severe malaria. Am J TropMedHyg2006 75 790-797.
- Beare NA, Southern C, Chalira C, Taylor TE, Molyneux ME, Harding SP; Prognostic significance and course of retinopathy in children with severe malaria. Arch Ophthalmol. 2004 Aug;122(8):1141-7.
- Lewallen S, Taylor TE, Molyneux ME, Wills BA, Courtright P, Ocular fundus findings in Malawian children with cerebral malaria. Arch Ophthalmol 1993 100 857-861
- Hirneiss C, Klauss V, Wilke M, Kampik A, Taylor T, Lewallen S. Ocular changes in tropical malaria with cerebral involvement: results from the Blantyre malaria project. Klin Monatsbl Augenheilkd. 2005;222:704–708