Shock complicating severe falciparum malaria in European adults.
OBJECTIVE
To study adult patients with severe falciparum malaria who developed shock.


METHODS
Retrospective study from 1987 to 1993.


METHODS
Medical intensive care unit in a university hospital.


METHODS
14 patients admitted with severe falciparum malaria who developed shock. All received intravenous quinine.


RESULTS
The mean Simplified Acute Physiology Score II was 59.5 +/- 7.1; 2.6 +/- 0.4 criteria defining severe disease were present on admission in 12 patients; and initial parasitemia was 21 +/- 6%. Twelve patients received inotropic drugs. Pulmonary artery catheterization showed the following results in 7 patients: mean arterial pressure 57 +/- 4 mmHg; pulmonary artery occlusion pressure 11 +/- 1 mmHg; cardiac index 5.5 +/- 0.91.min-1.m-2, and systemic vascular resistance index 783 +/- 122 dyne.s.cm-5.m-2. Seven patients had evidence of bacterial infection at the time of shock. Of the 7 deaths (50%), 5 were due to shock, with documented bacterial infection in all patients and persistent parasitemia in 4.


CONCLUSIONS
Shock complicating severe falciparum malaria in adults is associated with peripheral vasodilation and carries a poor prognosis. In falciparum malaria with shock, bacterial coinfection should be suspected immediately and treated empirically with broad-spectrum antibiotics. Nevertheless, Plasmodium falciparum may contribute directly or indirectly to the onset of shock.
Bruneel
F
F
Clinique de Réanimation des Maladies Infectieuses, Groupe Hospitalier Bichat-Claude Bernard, Paris, France.
Gachot
B
B
Timsit
J F
JF
Wolff
M
M
Bédos
J P
JP
Régnier
B
B
Vachon
F
F
D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy; D008297:Male; D011803:Quinine / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000209:etiology*
D000962:Antimalarials; D011803:Quinine