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Characterization of severe Plasmodium falciparum malaria patients in an Angolan general ICU

  • Esmael Tomás1,
  • E Filipe1,
  • E Viegas1,
  • A Sá2,
  • F Silva1,
  • L Antunes1 and
  • E Lafuente2
Malaria Journal20109(Suppl 2):P52

Published: 20 October 2010


MalariaPlasmodium FalciparumQuinineMalaria SeverityArtemether


Malaria is the most important human parasitic disease, causing an estimated 500 million cases and more than 1 million deaths annually. Plasmodium falciparum is responsible for the most serious form of the disease with a significant mortality rate.


To characterize severe Plasmodium falciparum malaria patterns in patients admitted to an Angolan general ICU.


A retrospective study based on medical records of adult patients with severe Plasmodium falciparum malaria admitted between January 2006 and December 2008 at an Angolan University-affiliated teaching hospital. We collected data on demographics, malaria-related immunity status, clinical presentation, WHO malaria severity criteria, laboratory findings and outcome. Continuous data were analyzed with Students t-test. A P of less than 0.05 was regarded to be significant.


Out of 114 patients admitted with diagnosis of malaria, we enrolled 56 patients. Forty-four (79%) were males. The mean age was 43.0±12.9. Twenty-eight (50%) were nonimmune and only two were adherent to chemoprophylaxis, but reported taking it incorrectly. Fifty-two percent were admitted during the second trimester. The mean APACHE II was 15.4±8.7 with a mean predicted dead rate of 25.9%. The mean SOFA on admission was 7.6±3.6. Fever (82%) followed by headache (41%) and gastrointestinal symptoms (36%) were the most common symptoms on admission and jaundice (61 %) the most common sign. The mean duration of symptoms prior to presentation at the ED was 6.1 ±4.3 days. Malaria diagnosis was confirmed within 24 hours of admission to our hospital In all the cases. Twelve patients presented 2 or more WHO severity major criteria. Forty-one patients were treated with quinine and twelve with artemether. Nineteen patients (34%) required ventilatory support, twenty (36%) intermittent hemodialysis and twelve (21%) vasopressor support. The mean ICU length of stay was 5.5±3.8 days. The 2-day mortality rate and total ICU mortality rate recorded was 10.7% and 37.5%, respectively.
Table 1

Characteristics of survival and nonsurvival groups


Survival (n=35)

Non-survival (n=21)


Age, Mean ± SD

43.7 ± 12.5

42.0 ± 14.0


APACHE 11, Mean ± SD

12.1 ± 6.2

21.0 ± 9.4


SOFA on admission (total), Mean ± SD

6.5 ± 3.3

9.6 ± 3.5


Non-Immune, n(%)


10 (47.6)


Two or more WHO severity criteria, n(%)

1 (0.3)

11 (52.4)


Platelets (x103/mm3), Mean ± SD

85.8 ± 86.3

65.3 ± 57.3


Bilirubin (mg/dl), Mean ± SD

4.8 ± 4.7

6.9 ± 7.2


Creatinine (mg/dl), Mean ± SD

3.6 ± 3.1 5

3.9 ± 2.6


C-reactive protein (mg/l), Mean ± SD

118.0 ± 87.5

140.0 ± 103.0


Arterial lactates (mmol/l), Mean ± SD

3.4 ± 2.89

5.4 ± 4.6


Parasitemia (x103parasites/mm3), Mean ± SD

30.5 ± 28.8

27.8 ± 36.7



In this review, the criteria usually pointed as predictors of a poor outcome on sepsis cases were found to have statistical significance in malaria-related deaths.

Authors’ Affiliations

Clínica Sagrada Esperança, ICU, Angola
Centro Hospitalar Tamega Sousa, ICU, Portugal


  1. WHO: Trans RSoc Trop Med Hyg. 2000Google Scholar
  2. Mphahlele : Polskie archiwum medycyny wewnetrznej. 2008Google Scholar


© Tomás et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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