ASSOCIATION BETWEEN MEASURES OF VITAMIN-A AND THE OCULAR FUNDUS FINDINGS IN CEREBRAL MALARIA

Objective: To investigate the relationship between serum vitamin A lev els 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 ho spital 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 f indings and vitamin A measurements were sought. Results: The whitening of the retina that we have previously described in children with cere bral malaria was found to be associated with a mean +/- SD serum vitam in A level of 0.29 +/- 0.1 mu mol/L, compared with a mean vitamin A le vel of 0.41 +/- 0.2 mu mol/L in children without retinal whitening. Ch ildren 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 e vidence of chronic vitamin A deficiency. Conclusions: The retinal whit ening described in children with cerebral malaria is associated with l ow serum vitamin A levels and with abnormal conjunctival impression cy tology results and may be due to acute vitamin A deficiency at the tis sue level.