This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200206-631OCv1 167/5/684    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bruneel, F. Articles by Vachon, F. Search for Related Content PubMed PubMed Citation Articles by Bruneel, F. Articles by Vachon, F.

The Clinical Spectrum of Severe Imported Falciparum Malaria in the Intensive Care Unit

Report of 188 Cases in Adults

Clinique de Réanimation des Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris; Service de Réanimation, Hôpital André Mignot, Centre Hospitalier de Versailles, Le Chesnay; Service des Maladies Infectieuses et Tropicales, Centre Hospitalier d'Orléans-La Source, Orléans Cedex 2; Département de Biostatistique et Informatique Médicale, INSERM U-444, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris; and Service de Parasitologie, Hôpital Bichat-Claude Bernard, Paris, France

Correspondence and requests for reprints should be addressed to Michel Wolff, Service de Réanimation des Maladies Infectieuses, Hôpital Bichat Claude-Bernard, AP/HP, 40 rue Henri Huchard 75018, Paris, France. E-mail: michel.wolff{at}bch.ap-hop-paris.fr

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.

Key Words: coma • shock • acidosis • respiratory distress syndrome • infection

This article has been cited by other articles:

				A. Gonzalez, J. M. Nicolas, J. Munoz, P. Castro, J. Mas, M. E. Valls, J. R. Coma, J. Aibar, and J. Gascon Severe Imported Malaria in Adults: Retrospective Study of 20 Cases Am J Trop Med Hyg, October 1, 2009; 81(4): 595 - 599. [Abstract] [Full Text] [PDF]

				R. Martinez-Giron, J. G. Esteban, A. Ribas, and L. Doganci Protozoa in respiratory pathology: a review Eur. Respir. J., November 1, 2008; 32(5): 1354 - 1370. [Abstract] [Full Text] [PDF]

				P. J. Rosenthal Artesunate for the Treatment of Severe Falciparum Malaria N. Engl. J. Med., April 24, 2008; 358(17): 1829 - 1836. [Full Text] [PDF]

				M. R. Gillrie, G. Krishnegowda, K. Lee, A. G. Buret, S. M. Robbins, S. Looareesuwan, D. C. Gowda, and M. Ho Src-family kinase dependent disruption of endothelial barrier function by Plasmodium falciparum merozoite proteins Blood, November 1, 2007; 110(9): 3426 - 3435. [Abstract] [Full Text] [PDF]

				J. J.C. DE VRIES, S. VAN ASSEN, A. B. MULDER, and G. A. KAMPINGA POSITIVE BLOOD CULTURE WITH PLASMODIUM FALCIPARUM: CASE REPORT Am J Trop Med Hyg, June 1, 2007; 76(6): 1098 - 1099. [Abstract] [Full Text] [PDF]

				A. MORENO, A. GARCIA, M. CABRERA-MORA, E. STROBERT, and M. R. GALINSKI DISSEMINATED INTRAVASCULAR COAGULATION COMPLICATED BY PERIPHERAL GANGRENE IN A RHESUS MACAQUE (MACACA MULATTA) EXPERIMENTALLY INFECTED WITH PLASMODIUM COATNEYI Am J Trop Med Hyg, April 1, 2007; 76(4): 648 - 654. [Abstract] [Full Text] [PDF]

				I. P. Fraser, C. M. Cserti, and W. H. Dzik Case 32-2006 -- A 3-Year-Old Girl with Fever after a Visit to Africa N. Engl. J. Med., October 19, 2006; 355(16): 1715 - 1722. [Full Text] [PDF]

				G. Pasvol The treatment of complicated and severe malaria Br. Med. Bull., February 22, 2006; 75-76(1): 29 - 47. [Abstract] [Full Text] [PDF]

				M. L. Linenberger and T. H. Price Use of Cellular and Plasma Apheresis in the Critically Ill Patient: Part II: Clinical Indications and Applications J Intensive Care Med, March 1, 2005; 20(2): 88 - 103. [Abstract] [PDF]

				M. Ndao, E. Bandyayera, E. Kokoskin, D. Diemert, T. W. Gyorkos, J. D. MacLean, R. St. John, and B. J. Ward Malaria "epidemic" in Quebec: diagnosis and response to imported malaria Can. Med. Assoc. J., January 4, 2005; 172(1): 46 - 50. [Abstract] [Full Text] [PDF]

				M. J. Tobin Critical Care Medicine in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 239 - 253. [Full Text] [PDF]

				N. J. White The Management of Severe Falciparum Malaria Am. J. Respir. Crit. Care Med., March 1, 2003; 167(5): 673 - 674. [Full Text] [PDF]