From: Severe imported malaria in an intensive care unit: a review of 59 cases
Manifestation | Definition |
---|---|
Cerebral malaria | Impaired consciousness or unrousable coma not attributable to any other cause, with a Glasgow score ≤ 9. Prostration, i.e. generalized weakness so that the patient is unable to walk, or sit up without assistance Failure to feed Multiple convulsions - more than two episodes in 24 h |
Severe anaemia | Haematocrit < 15% or haemoglobin < 5 g/dl in the presence of parasite count > 10 000/μl |
Renal failure | Urine output < 400 ml/24 hours in adults (< 12 ml/kg/24 hours in children) and a serum creatinine > 265 μmol/l (> 3.0 mg/dl) despite adequate volume repletion |
Pulmonary oedema and ARDS | The acute lung injury score is calculated on the basis of radiographic densities, severity of hypoxemia, and positive end-expiratory pressure |
Hypoglycaemia | Whole blood glucose concentration < 2.2 mmol/l (< 40 mg/dl) |
Circulatory collapse | Systolic blood pressure < 70 mmHg in patients > 5 years of age (< 50 mmHg in children aged 1-5), with cold clammy skin or a core-skin temperature difference > 10°C |
Abnormal bleeding and/or disseminated intravascular coagulation | Spontaneous bleeding from gums, nose, gastrointestinal tract, or laboratory evidence of disseminated intravascular coagulation |
Repeated generalized seizures | ≥2 seizures observed within 24 hours |
Acidaemia/acidosis | Arterial pH < 7.25 or acidosis (plasma bicarbonate < 15 mmol/l) |
Macroscopic haemoglobinuria | Haemolysis not secondary to glucose-6-phospha e dehydrogenase deficiency |
Impaired consciousnesss | Rousable mental condition |
Prostration or weakness | Generalized weakness so that the patient is unable to walk or sit up without assistance |
Hyperparasitaemia | > 2% parasitized erythrocytes or > 250 000 parasites/μl (in non-immune individuals) |
Hyperpyrexia | Core body temperature > 40°C |
Hyperbilirubinaemia | Total bilirubin > 43 μmol/l (> 2.5 mg/dl) |