Association between measures of vitamin A and the ocular fundus findings
in cerebral malaria.
Lewallen S; Taylor TE; Molyneux ME; Semba RD; Wills BA; Courtright P
Arch Ophthalmol 1998 Mar;116(3):293-6
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 degrees 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
micromol/L, compared with a mean vitamin A level of 0.41+/-0.2 micromol/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.