期刊
AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE
卷 84, 期 1, 页码 141-147出版社
AMER SOC TROP MED & HYGIENE
DOI: 10.4269/ajtmh.2011.10-0205
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资金
- Malaria Research Group of Chittagong Bangladesh Mahidol-Oxford Tropical Medicine Research Unit
- Wellcome Trust of Great Britain
- British Council
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 < 00001), 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
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