Severe and complicated malaria in KwaZulu-Natal.
OBJECTIVE
To describe severe and complicated malaria, including the common complications, causes of death and predictors of poor outcome.


METHODS
Retrospective case series.


METHODS
King Edward VIII Hospital, Durban, Natal, a referral centre.


METHODS
One hundred and forty-three consecutive patients (88 males, 55 females; median age 25 years, range 2-86 years) admitted with a microscopic diagnosis of Plasmodium falciparum malaria from 1984 to 1991.


METHODS
A univariate analysis comparing survival and death for categorical and continuous data for various complications was performed using the t-test or chi 2-test (or Fisher's exact test in the case of small cell sizes). Variables that showed significance on univariate analysis (P < 0.1) were used in a multivariate analysis to determine which contributed independently to survival or death.


RESULTS
The case fatality rate was 11.1% (15/135) and the commonest complications were hyperparasitaemia (30%), renal failure (17%), acidaemia (14%), jaundice (10.4%) and cerebral malaria (6%). The commonest complications in patients who died were renal failure (10 patients), cerebral malaria (7), hyperparasitaemia (6) and severe anaemia (5). Multivariate analysis using a logistic regression model showed a high parasite load and cerebral malaria (relative risks of 11.9 and 51.8 respectively) and high urea levels to be the significant predictors of poor outcome (95% confidence intervals 1.53-91.9, 2.74-100.0 and 1.01-1.09, respectively).


CONCLUSIONS
Patients with high parasite densities, cerebral involvement and renal dysfunction need urgent attention with parenteral chemotherapy, intravenous fluid replacement and early referral to a tertiary hospital with facilities for intensive monitoring and supportive treatment.
Soni
P N
PN
Department of Medicine, University of Natal, Durban.
Gouws
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use; D002648:Child; D002738:Chloroquine / Q000627:therapeutic use; D004351:Drug Resistance; D005260:Female; D006801:Humans; D016015:Logistic Models; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000187:drug effects; D011803:Quinine / Q000627:therapeutic use; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology
D000962:Antimalarials; D002738:Chloroquine; D011803:Quinine