Association Between Measures of Vitamin A and the Ocular Fundus Findings in Cerebral Malaria | Infectious Diseases | JAMA Ophthalmology | JAMA Network
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Clinical Sciences
March 1998

Association Between Measures of Vitamin A and the Ocular Fundus Findings in Cerebral Malaria

Author Affiliations

From the British Columbia Centre for Epidemiologic and International Ophthalmology, Vancouver (Drs Lewallen and Courtright); International Eye Foundation (Drs Lewallen and Courtright), Malaria Project and Wellcome Trust Centre, University of Malawi College of Medicine (Drs Molyneux and Wills), Blantyre; College of Osteopathic Medicine, Michigan State University, East Lansing (Dr Taylor); Liverpool School of Tropical Medicine, Liverpool, England (Dr Molyneux); and the Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Md (Dr Semba).

Arch Ophthalmol. 1998;116(3):293-296. doi:10.1001/archopht.116.3.293

Objective  To investigate the relationship between serum vitamin A levels and conjunctival impression cytology and retinal whitening present in Malawian children with cerebral malaria.

Methods  Standard retinal examination and conjunctival impression cytology were performed at hospital admission on 101 consecutively admitted children with cerebral malaria. Blood samples were drawn from 56 children at 24 hours, frozen at −20°C, and transported for assessment of vitamin A levels by high-performance liquid chromatography. Associations among fundus findings and vitamin A measurements were sought.

Results  The whitening of the retina that we have previously described in children with cerebral malaria was found to be associated with a mean±SD serum vitamin A level of 0.29±0.1 µmol/L, compared with a mean vitamin A level of 0.41±0.2 µmol/L in children without retinal whitening. Children with retinal whitening were 2.77 (95% CI, 1.06-7.3) times more likely to have abnormal conjunctival impression cytology results than those without whitening. No child had any clinical or ophthalmologic evidence of chronic vitamin A deficiency.

Conclusions  The retinal whitening described in children with cerebral malaria is associated with low serum vitamin A levels and with abnormal conjunctival impression cytology results and may be due to acute vitamin A deficiency at the tissue level.