Severe and complicated malaria. Report of six cases
Botella de Maglia, J.; Espacio Casanovas, A.
Revista Clinica Espanola 198(8): 509-513
1998
ISSN/ISBN: 0014-2565 PMID: 9774880 Document Number: 487108
During 1987-96, 6 patients (3 men, 3 women; aged 26-49 years) were admitted to the Intensive Care Unit, Hospital La Fe, Valencia, Spain, with severe and complicated falciparum malaria (6.7+or-2.7 WHO criteria). All patients acquired the disease while travelling in tropical Africa without appropriate chemoprophylaxis. The clinical manifestations included hyperpyrexia (all patients), chills (4), sweating (2), asthenia (3), anorexia (2), headache (1), arthralgias (1), vomiting (4), diarrhoea or abdominal discomfort (3), jaundice (2) and disturbances of consciousness (4). All patients had anaemia, thrombocytopenia, hyponatraemia, hypoproteinaemia, hypoalbuminaemia, hypocalcaemia and acute renal failure, in 1 case associated with anuria. A low grade parasitaemia was observed in 2 patients and a high grade parasitaemia (20%-58% of erythrocytes) in 4. Exchange transfusion was performed only in high parasitaemic patients and all of them survived. All patients were treated with quinine, a sulfonamide and pyrimethamine. Additionally, 5 patients received oxytetracycline, doxycycline or clindamycin. Three patients required haemodialysis. Five patients had delirium, coma or seizures. All patients had at least 1 sign of hepatic impairment: liver enlargement, jaundice or increased bilirubin or aminotransferase levels. Two patients had spleen enlargement. Laboratory findings suggested disseminated intravascular coagulation in 4 cases. Four patients developed pulmonary changes and 3 of them required mechanical ventilation. A Swan-Ganz catheter was placed in 4 patients. In 3 of them (2 with pulmonary oedema) the pulmonary capillary wedge pressure was initially increased, suggesting a cardiogenic or hypervolaemia mechanism, but soon returned to normal level. One patient with low grade parasitaemia died of adult respiratory distress syndrome after 18 days. In this series of patients, the degree of parasitaemia was not related to the severity of the disease.