Volume 9 Supplement 2

Parasite to Prevention: Advances in the understanding of malaria

Open Access

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

https://doi.org/10.1186/1475-2875-9-S2-P52

Published: 20 October 2010

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

 

Survival (n=35)

Non-survival (n=21)

p

Age, Mean ± SD

43.7 ± 12.5

42.0 ± 14.0

0.66

APACHE 11, Mean ± SD

12.1 ± 6.2

21.0 ± 9.4

<0.0001

SOFA on admission (total), Mean ± SD

6.5 ± 3.3

9.6 ± 3.5

0.0013

Non-Immune, n(%)

18(51.4)

10 (47.6)

0.79

Two or more WHO severity criteria, n(%)

1 (0.3)

11 (52.4)

<0.0001

Platelets (x103/mm3), Mean ± SD

85.8 ± 86.3

65.3 ± 57.3

0.35

Bilirubin (mg/dl), Mean ± SD

4.8 ± 4.7

6.9 ± 7.2

0.08

Creatinine (mg/dl), Mean ± SD

3.6 ± 3.1 5

3.9 ± 2.6

0.67

C-reactive protein (mg/l), Mean ± SD

118.0 ± 87.5

140.0 ± 103.0

0.45

Arterial lactates (mmol/l), Mean ± SD

3.4 ± 2.89

5.4 ± 4.6

0.019

Parasitemia (x103parasites/mm3), Mean ± SD

30.5 ± 28.8

27.8 ± 36.7

0.73

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.

Authors’ Affiliations

(1)
Clínica Sagrada Esperança, ICU
(2)
Centro Hospitalar Tamega Sousa, ICU

References

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

Copyright

© 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 (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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