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

Introduction

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.

Objective

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

Methods

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.

Results

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

Conclusions

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.