Acute lung injury complicating imported Plasmodium falciparum malaria.
OBJECTIVE
To characterize adult patients with acute lung injury complicating severe imported Plasmodium falciparum malaria.


METHODS
Retrospective study of patients with severe P falciparum malaria admitted to the medical ICU of a university hospital infectious diseases department.


METHODS
Forty adults with complicated malaria, with (group 1, 12 patients) or without (group 2, 28 patients) acute lung injury.


RESULTS
Patients with acute lung injury had a higher simplified acute physiology score on admission (24.2 +/- 3.2 vs 13.7 +/- 0.7 in group 2, p < 0.0001) and a longer time interval to adequate antimalarial therapy (8.8 +/- 2.5 vs 4.9 +/- 0.6 days in group 2, p = 0.046). Of the nine group 1 patients given mechanical ventilation, eight had a PaO2/FIO2 < or = 200 mm Hg. Two patients with moderate hypoxemia received oxygen through a nasal tube and one received continuous positive airway pressure via a face mask. Acute renal failure, unrousable coma, metabolic acidosis, and shock were significantly more common among group 1 patients. The number of complications of malaria was significantly higher in patients with acute lung injury (4.7 +/- 0.5 vs 1.6 +/- 0.1 in group 2, p < 0.0001). Five patients, including four with acute lung injury, had evidence of bacterial infection (pneumonia or primary bacteremia) at ICU admission. Four patients with acute lung injury died (33%) vs one patient without acute lung injury (4%, p = 0.022).


CONCLUSIONS
Acute lung injury is more likely to occur in patients with extremely severe, multisystemic P falciparum malaria. In patients with acute lung injury and septic shock, bacterial coinfection should be suspected and treated empirically since it contributes substantially to early mortality.
Gachot
B
B
Clinique de Réanimation des Maladies Infectieuses, Groupe Hospitalier Bichat-Claude Bernard, Paris, France.
Wolff
M
M
Nissack
G
G
Veber
B
B
Vachon
F
F
D000138:Acidosis / Q000209:etiology; D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000349:Africa; D001424:Bacterial Infections / Q000150:complications; D016022:Case-Control Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D011803:Quinine / Q000627:therapeutic use; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012772:Shock, Septic / Q000209:etiology; D013020:South America
D011803:Quinine