Journal Article

Severe Imported Falciparum Malaria: A Cohort Study in 400 Critically Ill Adults

Tubach, Florence, Mira, Jean-Paul, Cohen, Yves, Frenoy, Eric, Trouillet, Jean-Louis, Le Bras, Jacques, Schortgen, Frederique, Georges, Hugues, Corne, Philippe, Bruneel, Fabrice, Megarbane, Bruno, Durand, Remy, Camus, Christophe, Roy, Carine, Hyvernat, Herve, Peytel, Eric, Nicolet, Laurent, Wolff, Michel, Meybeck, Agnes, Azoulay, Elie

2010

Overview

Large studies on severe imported malaria in non-endemic industrialized countries are lacking. We sought to describe the clinical spectrum of severe imported malaria in French adults and to identify risk factors for mortality at admission to the intensive care unit. Retrospective review of severe Plasmodium falciparum malaria episodes according to the 2000 World Health Organization definition and requiring admission to the intensive care unit. Data were collected from medical charts using standardised case-report forms, in 45 French intensive care units in 2000-2006. Risk factors for in-hospital mortality were identified by univariate and multivariate analyses. Data from 400 adults admitted to the intensive care unit were analysed, representing the largest series of severe imported malaria to date. Median age was 45 years; 60% of patients were white, 96% acquired the disease in sub-Saharan Africa, and 65% had not taken antimalarial chemoprophylaxis. Curative quinine treatment was used in 97% of patients. Intensive care unit mortality was 10.5% (42 deaths). By multivariate analysis, three variables at intensive care unit admission were independently associated with hospital death: older age (per 10-year increment, odds ratio [OR], 1.72; 95% confidence interval [95%CI], 1.28-2.32; P = 0.0004), Glasgow Coma Scale score (per 1-point decrease, OR, 1.32; 95%CI, 1.20-1.45; P<0.0001), and higher parasitemia (per 5% increment, OR, 1.41; 95%CI, 1.22-1.62; P<0.0001). In a large population of adults treated in a non-endemic industrialized country, severe malaria still carried a high mortality rate. Our data, including predictors of death, can probably be generalized to other non-endemic countries where high-quality healthcare is available.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Adults / Aged / Antimalarials / Antimalarials - therapeutic use / Charts / Cohort analysis / Cohort Studies / Coma / Confidence intervals / Critical Care and Emergency Medicine / Critical Illness / Data processing / Erythrocytes / Female / Health care / Hospitals / Humans / Infectious Diseases / Intensive care / Intensive care units / Life Sciences / Malaria / Malaria, Falciparum / Malaria, Falciparum - drug therapy / Malaria, Falciparum - physiopathology / Male / Microbiology/Parasitology / Middle Aged / Mortality / Multivariate analysis / Neurological Disorders/Infectious Diseases of the Nervous System / Parasitemia / Patients / Plasmodium falciparum / Quinine / Retrospective Studies / Risk analysis / Risk factors / Santé publique et épidémiologie / Sepsis / Severity of Illness Index / Vector-borne diseases