Published ahead of print on October 31, 2002, doi:10.1164/rccm.200206-631OC
Am. J. Respir. Crit. Care Med., Volume 167, Number 5, March 2003, 684-689
A more recent version of this article appeared on March 1, 2003
Submitted on June 28, 2002
Accepted on October 27, 2002
The clinical spectrum of severe imported falciparum malaria in the ICU: Report of 188 cases in adults
Fabrice Bruneel1, Laurent Hocqueloux2, Corinne Alberti3, Michel Wolff4*, Sylvie Chevret3, Jean-Pierre Bedos5, Remy Durand6, Jacques Le Bras6, Bernard Regnier4, and Francois Vachon4
1 Service de Reanimation des Maladies Infectieuses, Hopital Bichat-Claude Bernard, AP/HP, Paris, France; Service de Reanimation, Hopital Andre Mignot, Le Chesnay, France,
2 Service de Reanimation des Maladies Infectieuses, Hopital Bichat-Claude Bernard, AP/HP, Paris, France; Service des Maladies Infectieuses et Tropicales, Centre hospitalier d'Orleans, Orleans, France,
3 Departement de Biostatistique et Informatique Medicale, INSERM U-444, Hopital St Louis, AP/HP, Paris, France,
4 Service de Reanimation des Maladies Infectieuses, Hopital Bichat-Claude Bernard, AP/HP, Paris, France,
5 Service de Reanimation, Hopital Andre Mignot, Le Chesnay, France,
6 Service de Parasitologie, Hopital Bichat Claude Bernard, Paris, France
* To whom correspondence should be addressed. E-mail: michel.wolff{at}bch.ap-hop-paris.fr.
Little is known about severe imported malaria in non-endemic industrialized countries. The purpose of this retrospective study was to describe the clinical spectrum of severe imported malaria in adults and to determine factors present at admission and associated with in-ICU mortality. This retrospective study evaluated the 188 patients admitted to our ICU in 1988-1999 with severe and/or complicated imported malaria. Among them, 93 had strictly defined severe malaria and 95 had less severe malaria. Mean age was 38 years; 51% of patients were
nonimmune Caucasians, 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 co-infection is not infrequent and may contribute to death. Severe imported malaria remains a major threat to travelers. In our population, the most relevant WHO major defining criteria were coma, shock, pulmonary edema, and acidosis.
Key words: Coma, shock, acidosis, respiratory distress syndrom, infection
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