Retrospective study of imported falciparum malaria in French paediatric intensive care units.
OBJECTIVE
The World Health Organization (WHO) severity criteria for paediatricPlasmodium falciparum(Pf) malaria are based on studies in countries of endemic malaria. The relevance of these criteria for other countries remains unclear. We assessed the relevance of these criteria in an industrialised country.


METHODS
Retrospective case-control study.


METHODS
Eight French university hospitals, from 2006 to 2012.


METHODS
Children with Pf malaria admitted to paediatric intensive care units (cases: n=55) or paediatric emergency departments (controls: n=110).


METHODS
Descriptive analysis of WHO severity criteria and major interventions (mechanical ventilation, blood transfusion, fluid challenge, treatment of cerebral oedema, renal replacement therapy). Thresholds were set by receiver operating characteristics curve analysis.


RESULTS
Altered consciousness (71% vs 5%), shock (24% vs 1%), renal failure (20% vs 1%), anaemia <50 g/L (7% vs 2%), acidosis (38% vs 0%), bilirubin level >50 µmol/L (25% vs 8%) and parasitaemia >10% (30% vs 8%) were more frequent in cases (p<0.01). All these criteria were associated with major interventions (p<0.001). Respiratory distress (six cases), and hypoglycaemia (two cases) were infrequent. Thrombocytopenia <50 000/mm3(46% vs 7%) and anaemia (haemoglobin concentration <70 g/L (41% vs 13%)) were more frequent in cases (p<0.0001).


CONCLUSIONS
The WHO severity criteria for paediatric Pf malaria are relevant for countries without endemic malaria. The infrequent but severe complications also provide a timely reminder of the morbidity and mortality associated with this condition worldwide. In non-endemic countries haemoglobin <70 g/L and platelet count <50 000/mm3could be used as additional criteria to identify children needing high level of care.
Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Justine
J
Lanneaux
Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Stéphane
S
Dauger
Paediatric Emergency Department, AP-HP, Hôpital Bicêtre, Université Paris Sud, Le Kremlin-Bicêtre, France.
Luu-Ly
LL
Pham
Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Jérôme
J
Naudin
Department of General Paediatrics, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Albert
A
Faye
Paediatric Emergency Department, HCL, HFME Lyon, Université de Lyon 1, Lyon, France.
Yves
Y
Gillet
Department of Paediatrics, APHM, CHU Timone Enfants, Marseille, France.
Emmanuelle
E
Bosdure
Paediatric Emergency Department, AP-HP, Hôpital Armand Trousseau, Université Pierre et Marie Curie Paris 6, Paris, France.
Ricardo
R
Carbajal
Paediatric Emergency and Infectious Diseases Departments, Université de Lille, Hôpital R. Salengro, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
François
F
Dubos
Paediatric Intensive Care Department, APHM, CHU Nord, Marseille, France.
Renaud
R
Vialet
Paediatric Emergency Department, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Gérard
G
Chéron
Paediatric Emergency Department, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.|Clinical Epidemiology Unit ECEVE, INSERM UMR 1123, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
François
F
Angoulvant
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005602:France / Q000453:epidemiology; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies
Infectious Diseases; Intensive Care; Parasitology; malaria