title: The clinical spectrum of severe imported falciparum malaria in the intensive care unit: report of 188 cases in adults.
abstract: Little is known about severe imported malaria in nonendemic industrialized countries. The purpose of this retrospective study was to describe the clinical spectrum of severe imported malaria in adults and to determine factors that were present at admission and were associated with in-intensive care unit mortality. This retrospective study evaluated the 188 patients who were admitted to our intensive care unit in 1988-1999 with severe and/or complicated imported malaria. Among them, 93 had strictly defined severe malaria, and 95 had less severe malaria. The mean age was 38 years, 51% of patients were nonimmune whites, 94% acquired Plasmodium falciparum in sub-Saharan Africa, and 96% had taken inadequate antimalarial chemoprophylaxis. Mortality was 11% (10 patients) in the severe malaria group, whereas no patients died in the less severe malaria group (p = 0.002). In the bivariable analysis, the main factors associated with death in the severe malaria group were the Simplified Acute Physiology Score, shock, acidosis, coma, pulmonary edema (p < 0.001 for each), and coagulation disorders (p = 0.002). Bacterial coinfection is not infrequent and may contribute to death. Severe imported malaria remains a major threat to travelers. In our population, the most relevant World Health Organization major defining criteria were coma, shock, pulmonary edema, and acidosis.
authors.affiliation: Clinique de Réanimation des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bruneel
authors.forename: Laurent
authors.initials: L
authors.lastname: Hocqueloux
authors.forename: Corinne
authors.initials: C
authors.lastname: Alberti
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chevret
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bédos
authors.forename: Rémy
authors.initials: R
authors.lastname: Durand
authors.forename: Jacques
authors.initials: J
authors.lastname: Le Bras
authors.forename: Bernard
authors.initials: B
authors.lastname: Régnier
authors.forename: François
authors.initials: F
authors.lastname: Vachon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000962:Antimalarials / Q000008:administration & dosage; D017714:Community-Acquired Infections / Q000453:epidemiology; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology; D003627:Data Interpretation, Statistical; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D005602:France / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006801:Humans; D007275:Injections, Intravenous; D007362:Intensive Care Units; D016778:Malaria, Falciparum / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control / Q000628:therapy; D008297:Male; D015767:Mefloquine / Q000008:administration & dosage; D008875:Middle Aged; D010616:Phenanthrenes / Q000008:administration & dosage; D011803:Quinine / Q000008:administration & dosage; D012189:Retrospective Studies; D014195:Travel; D014944:World Health Organization
chemical_list: D000962:Antimalarials; D010616:Phenanthrenes; D011803:Quinine; C023768:halofantrine; D015767:Mefloquine