Critical Care and Shock

Outcome of severe falciparum malaria in an intensive care unit

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Objective: Plasmodium falciparum infection is responsible for most malaria-related mortality and morbidity. We aimed at studying the initial clinical presentation and subsequent outcome of adult patients admitted to the ICU with severe falciparum malaria.

Design: Prospective observational study.

Setting: Intensive care unit of a 1300 bedded tertiary care hospital at Varanasi, India.

Patients and participants: Patients aged more than 15 years fulfilling one or more of the WHO criteria for severe falciparum malaria were included.

Intervention: All patients were managed as per the initial clinical presentation.

Measurements and results: A total of 34 patients (23 males and 11 females) were included in the study. Twelve patients presented with coma, nine with shock, seven with generalized convulsions, four with ARDS, and the remaining two with spontaneous bleeding from multiple sites. Of these patients, seven survived from coma, two from shock, three from generalized convulsion, and one from ARDS. Twenty one patients died (12 from renal failure, five from multi-organ failure, and four from DIC) during their treatment in ICU, of whom 17 had on admission APACHE II score of >20. Of the 11 female patients, three were pregnant at the time of admission, all of whom died due to multi-organ failure.

Conclusion: The most common mode of presentation of severe falciparum malaria was unarousable coma. Patients admitted to the ICU for neurological complications of malaria had a better prognosis than those admitted for other severe complications. APACHE II score can be a useful prognostic marker in cases of severe falciparum malaria. Renal failure was the most common cause of death in cases of severe falciparum malaria and was usually unresponsive to peritoneal dialysis.

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