title: [Severe imported malaria: case report].
abstract: OBJECTIVE
  Malaria is still considered a major global health problem. The severity form of the disease is caused, mainly by P. falciparum and may occur together with cerebral, kidney, pulmonary, hematologic, circulatory and hepatic complications. This report is about a patient with a case of severe imported malaria.
  
  
  METHODS
  A 30-years-old man, mulatto, Philippine, sailor, coming from a ship arriving from Nigeria, with a history of abdominal pain on the right hypochondrium, jaundice, fever, decreased in the consciousness. Lab tests made upon his admission showed hyperbilirubinemia at a level of 50 mg/dL, severe metabolic acidosis, thrombocytopenia, creatinine levels of 5.6 mg/dL and leukocytosis with deviation through metamyelocytes. The APACHE II score was 37, with death estimated risk of 88%. During his stay at the hospital, P. Falciparum Malaria was diagnosed through the thick drop test. And, even with the adequate anti-malaria therapy, the patients condition evolved to an acute renal failure requiring hemodialis; acute respiratory distress syndrome (ARDS); septic shock, and hematological disorders, forming a multiple organ dysfunction syndrome (MODS). After being discharged from the hospital, the patient did not present any cerebral, pulmonary or kidney sequel.
  
  
  CONCLUSIONS
  From the criteria described in medical literature to define critical malaria, the patient fulfilled the following: acute renal failure, ARDS, metabolic acidosis, altered level of consciousness, macroscopic hemoglobinuria, hyperparasitism and hyperbilirubinemia, related to a lethality rate of over 10%, depending on early treatment and available resources. Severe malaria requires fast diagnosis allied to a quick access to an intensive care treatment, since any delay increases the morbid-mortality of the disease.
authors.affiliation: CTI, Clínica São Vicente, Rio de Janeiro.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Alves
authors.affiliation: CTI, Clínica São Vicente, Rio de Janeiro.
authors.forename: Andréa
authors.initials: A
authors.lastname: Martins
authors.affiliation: UNIRIO.
authors.forename: Samantha
authors.initials: S
authors.lastname: Adolphsson
authors.affiliation: UFRJ, Rio de Janeiro.
authors.forename: Bruno
authors.initials: B
authors.lastname: Bockorny
authors.affiliation: UFRJ, Rio de Janeiro.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Carleti
authors.affiliation: UFRJ, Rio de Janeiro.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Cabral
authors.affiliation: Clínica médica.
authors.forename: Antônio Carlos P
authors.initials: AC
authors.lastname: Souza
authors.affiliation: CTI, Clínica São Vicente, Rio de Janeiro.
authors.forename: Arthur
authors.initials: A
authors.lastname: Vianna