Malaria remains a major problem in many parts of the world. Approximately 500 million people are affected annually, and about three million, mostly children, die of falciparum malaria each year. [1][2][3][4][5] In areas of endemic malaria, the most common clinical presentation is that of uncomplicated infection with prompt recovery after treatment.6,7 However, in nonimmune individuals, malaria may present in its most severe forms. 2,5,6,8 Despite a vigorous program of malaria control in the Kingdom of Saudi Arabia, the infection is still endemic in the southwestern area of the country.9 As a result of continued preventive measures, the epidemiology of the disease may be changing, and the proportion of nonimmune individuals may increase. Furthermore, the emergence of chloroquine-resistant malaria in the neighboring country of Yemen has a major implication for the Gizan population.2,4 The frequency and clinical outcome of severe malaria may provide useful, albeit indirect, information on the emergence of antimalarial drug resistance in this region. We describe the clinicopathologic profile and mortality in patients treated for severe malaria in King Fahad Central Hospital (KFCH), Gizan, Saudi Arabia.
Materials and MethodsThe Gizan region is one of the 14 administrative provinces of Saudi Arabia. It is located on the Red Sea coast, about 1000 km southwest of Riyadh, and shares its border with Yemen to the east, and the Asir region to the north. The population of about one million is distributed mainly in the rural areas. All serious and complicated cases from the various general hospitals in the region are referred to the KFCH, which is the regional referral center. In addition, the emergency room is open 24 hours each day, allowing self-referral or presentation by those needing emergency care.The medical records of all cases of malaria admitted to the KFCH, from 1995 to 1997 (a three-year period), were analyzed. Malaria was diagnosed by the clinical presentation of fever, positive blood smear for asexual forms of Plasmodium falciparum, and response to antimalarial therapy. After a detailed history was obtained from either the patient or accompanying relatives, the patient was carefully examined. Thick and thin blood films were stained with Giemsa for the detection and characterization of malarial parasites. The parasite load was estimated to range from mild to severe on a scale of 1-4, corresponding approximately to <5%, 5%-10%, 10%-20%, and >20%, respectively. Additional investigations included the determination of hemoglobin level (Hb), white blood cell count (WBC), hematocrit, platelet count, reticulocyte count, mean corpuscular hemoglobin concentration, electrolytes, blood urea nitrogen (BUN), creatinine, blood glucose, bilirubin, aminotransferase, and lactic dehydrogenase in all the patients. Blood cultures, chest x-ray, abdominal ultrasound, urine and stool examination were done where indicated. Cerebrospinal fluid examination and CT scan of the brain were performed in some of the patients, as indicated clin...
