Critical Care Aspects of Malaria

Abstract

Malaria remains a major health problem in much of Asia and Africa. A steady number of cases of imported malaria are also seen in many countries of the developed world. Plasmodium falciparum malaria and to some extent malaria caused by other species of Plasmodium can lead to many complications such as acute respiratory distress syndrome (ARDS), cerebral malaria, acute renal failure, severe anemia, thrombocytopenia, and bleeding complications. About 10% of patients with severe malaria die, usually as a result of multiorgan dysfunction. Critical care physicians should be aware of the complications and management of severe malaria. There has been significant progress in the understanding of pathogenesis of severe malaria over the last decade. Effective management of severe malaria includes early suspicion, prompt diagnosis, early institution of appropriate antimalarial chemotherapy, and supportive care, preferably in an intensive care unit. In this article, we review the different manifestations of severe malaria as relevant to critical care physicians and discuss the principles of laboratory diagnosis and management.

Anti-Malarial and some Biochemical Indices of the Ethanol Extract of Zapoteca portoricensis Root on Malaria-Infected Mice

“…Among those infected, P. falciparum is the most common species identified (~75%) followed by P. vivax (~20%) (Nadjm and Behrens, 2012). Plasmodium falciparum accounts for the majority of deaths, (Sarkar et al, 2010) non-falciparum species have been found to be the cause of about 14% of cases of severe malaria in some groups (Nadjm and Behrens, 2012). Plasmodium vivax proportionally is more common outside of Africa (Arnott et al, 2012).…”

Hemoglobin Concentration and Parasitemia on Hospital Admission Predict Risk of Multiple Organ Dysfunction Syndrome among Adults with Malaria

“…4,9,19 Thus, simple, inexpensive tests that allow identification of patients at the highest risk of developing MODS could represent powerful tools to improve clinical outcomes of complicated malaria. Prior studies had found that either severe anemia, 6,9,12,[20][21][22] high parasitemia, 12,21,23 or plasma HRP-2 antigen 13,14 among malaria patients admitted to hospital were related to increased risk of ICU admission, MODS, and death. However, the strong interaction between anemia and parasitemia on SOFA scores and MODS had not been reported previously.…”

“…[1][2][3][4][5][6] Among complications requiring intensive care unit (ICU) admission are acute lung injury and acute respiratory distress syndrome, pulmonary edema, bacterial sepsis, 7 acute renal failure, 8 severe anemia, cerebral malaria, and thrombocytopenia. 9 The MODS is fatal in 10-49% of patients with malaria. 2,4,10,11 Early identification of patients at the highest risk of MODS and related complications would provide treating clinicians with opportunities to target those who could benefit from intensive or special care.…”

“…Some factors that predict multiple organ involvement include parasite virulence, host immune status, infection with Plasmodium falciparum, and plasma concentration of histidine-rich protein (HRP)-2 antigen. 4,9,[12][13][14] Nevertheless, whether a combination of easy-to-obtain, inexpensive markers of risk could predict the outcome of patients admitted to hospital with malaria has not been determined. The aim of this study was to examine risk factors for multiple organ dysfunction in patients admitted to hospital with malaria.…”

Advances in the treatment of malaria

“…68 Severe malaria should be regarded as a medical emergency and possibly managed in intensive care units (ICU) in order to assure adequate monitoring and treatment of organic dysfunctions. [69][70][71] The mainstay of severe malaria therapy, irrespective of the responsible plasmodium species, is a prompt, parenteral, effective anti-malarial treatment with the primary goal of preventing death and disabilities and, only secondarily, recrudescences. Since 2006 WHO recommends intravenous artesunate as first line regimen, preferred to intravenous quinine whenever 76,77 of a formulation currently approved by FDA as an investigational drug, that may be directly requested to CDC.…”