Complications of seasonal adult malaria at a central hospital.
Recently introduced chloroquine resistant malaria has altered the clinical picture and complicated the overall management of malaria. 113 adults with proved malaria admitted at Harare Central Hospital, Zimbabwe, were evaluated to determine the incidence, nature, relationship to morbidity and mortality and response to treatment of the complications due to malaria. 47.7 pc (52 of 109) patients had relatively chloroquine resistant malaria. 87.4 pc (99 of 113) had complications whose percentage frequency of occurrence were: Anaemia 51.2 pc, diarrhoea and/or vomiting 42.2 pc, cerebral malaria +/- fits 39.2 pc, renal insufficiency +/- hyperkalaemia 26.4 pc, hypoglycaemia 15.6 pc, jaundice 15.2 pc, neuro-psychiatric 15.0 pc, shock 10.6 pc, concurrent sepsis 8.9 pc, pulmonary oedema 3.5 pc and hyperpyrexia 1.7 pc. Multiple complications in the same patient were common. The combination of cerebral malaria and renal insufficiency had the worst mortality (p less than 0.001). All patients dialysed, however, survived. Non-iron deficiency anaemia, 91.7 pc (51 of 55) and diarrhoea and/or vomiting, were common, worsened morbidity but not mortality (p = 0.555). A seriously-ill patient with malaria should be suspected of having complications and chloroquine resistance and should be referred promptly to a centre with facilities for dialysis. Anti-malaria drugs should be mixed in a dextrose solution and iron supplements should not be given routinely.
Lutalo
S K
SK
Division of Medicine, Harare Central Hospital, Southerton, Zimbabwe.
Mabuwa
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D002675:Child, Preschool; D002738:Chloroquine / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D006769:Hospitals, General; D006801:Humans; D015994:Incidence; D008288:Malaria / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D008875:Middle Aged; D010963:Plasmodium falciparum; D011787:Quality of Health Care; D012621:Seasons; D015030:Zimbabwe / Q000453:epidemiology
D002738:Chloroquine