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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

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