title: Severe malaria in African adults living in a seasonal endemic area.
abstract: OBJECTIVE
  This study investigates severe malaria in African adults living in a seasonal endemic area.
  
  
  METHODS
  A prospective study of all adults admitted with severe malaria over 2 consecutive seasons: October 1990 till January 1991 and October 1991 till January 1992.
  
  
  METHODS
  ICU (15 beds) of Hôpital Principal, Dakar, Sénégal.
  
  
  METHODS
  23 patients: 14 men and 9 women with a mean age of 30 +/- 3 years were included in the study; all fulfilled the 1990 WHO criteria for severe malaria.
  
  
  RESULTS
  At admission, 12 patients were comatose (Glasgow Coma Scale < 10), 7 had generalized convulsions. Parasitaemia was 135 +/- 52 x 10(9)/l. Biological indications of severity were as follows: hypophosphataemia < 0.8 mmol/l in 14 cases, serum creatine phosphokinase > 500 IU/l in 15 cases; and PaO2 < 70 mmHg in 5 cases. Serum TNF alpha levels, measured in 16 cases, were increased at 298.4 +/- 63.5 pg/ml, serum levels of IL-6 and IL-2SR were also elevated: 609.5 +/- 304.2 pg/ml and 297.6 +/- 35.6 pg/ml respectively. Circulating IgM and IgG antibodies were found in 14 out of 16 patients. Serum levels of TNF alpha, IL-6 and IL-2SR correlated positively with each other. TNF alpha and IL-2SR were also positively correlated to parasitaemia. Intravenous therapy with quinine at loading dose was favorable in 19 patients. Four patients died during the study, 3 from multiple organ failure.
  
  
  CONCLUSIONS
  This work demonstrated that severe malaria in a seasonal endemic area displays original clinical features with a high rate of either cerebral malaria or multiple organ failure.
authors.affiliation: Service de Réanimation et de Soins Intensifs, Hôpital Principal, Dakar, Sénégal.
authors.forename: J M
authors.initials: JM
authors.lastname: Saïssy
authors.forename: M
authors.initials: M
authors.lastname: Vitris
authors.forename: B
authors.initials: B
authors.lastname: Diatta
authors.forename: J
authors.initials: J
authors.lastname: Kempf
authors.forename: F
authors.initials: F
authors.lastname: Adam
authors.forename: J L
authors.initials: JL
authors.lastname: Sarthou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016779:Malaria, Cerebral / Q000453:epidemiology / Q000209:etiology; D016778:Malaria, Falciparum / Q000097:blood* / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012621:Seasons; D012675:Senegal / Q000453:epidemiology; D012720:Severity of Illness Index; D015996:Survival Rate