{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T10:30:54Z","timestamp":1762079454508,"version":"build-2065373602"},"reference-count":30,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,1,11]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>In malaria endemic areas, a high proportion of children have detectable parasitemia but show no clinical symptoms. When comatose from a cause other than malaria, this group confounds the cerebral malaria (CM) definition, making accurate diagnosis challenging. One important biomarker of CM is malarial retinopathy, a set of specific features visible in the ocular fundus. In this study, we quantified the contribution of malarial retinopathy in discriminating malaria-caused coma from non\u2013malaria-caused coma. We estimated that 10% of our study cohort of <jats:italic>N<\/jats:italic> = 1,192 patients who met the WHO clinical definition of CM in Malawi had non-malarial coma based on a Gaussian mixture model using the parasite protein <jats:italic>Plasmodium falciparum<\/jats:italic> histidine-rich protein-2. A classification based on platelets, white blood cells, and retinopathy significantly improved the discriminative power of a previously established model including only platelets plus white blood cells (area under the receiver operating characteristic curve: 0.87 versus 0.75, <jats:italic>P<\/jats:italic> value &lt; 0.001). We conclude that malarial retinopathy is highly predictive of malaria-caused versus non\u2013malaria-caused coma and recommend that an ocular funduscopic examination to determine malarial retinopathy status be included in the assessment of parasitemic comatose African children.<\/jats:p>","DOI":"10.4269\/ajtmh.22-0547","type":"journal-article","created":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T15:31:16Z","timestamp":1670859076000},"page":"69-75","source":"Crossref","is-referenced-by-count":3,"title":["Using Malarial Retinopathy to Improve the Diagnosis of Pediatric Cerebral Malaria"],"prefix":"10.4269","volume":"108","author":[{"given":"Yuzhou","family":"Lin","sequence":"first","affiliation":[{"name":"Department of Statistics, Harvard University, Cambridge, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Tebulo","sequence":"additional","affiliation":[{"name":"Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dylan","family":"Small","sequence":"additional","affiliation":[{"name":"Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl","family":"Seydel","sequence":"additional","affiliation":[{"name":"Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi;"},{"name":"Department of Osteopathic Medical Specialties, Michigan State University, East Lansing, Michigan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terrie","family":"Taylor","sequence":"additional","affiliation":[{"name":"Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi;"},{"name":"Department of Osteopathic Medical Specialties, Michigan State University, East Lansing, Michigan;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Am J Trop Med Hyg","first-page":"673","article-title":"Pathophysiology of fatal falciparum malaria in African children","volume":"58","author":"Newton","year":"1998"},{"year":"2022","series-title":"WHO Guidelines for Malaria, 3 June 2022","key":"b2"},{"key":"b3","series-title":"Trop Med Int Health","first-page":"771","article-title":"Estimates of the burden of malaria morbidity in Africa in children under the age of 5 years","volume":"13","author":"Roca-Feltrer","year":"2008"},{"year":"2015","series-title":"World Malaria Report 2015","key":"b4"},{"key":"b5","series-title":"Nat Med","first-page":"143","article-title":"Differentiating the 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