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

Abstract

INTRODUCTION: Malaria is the most important human parasitic disease, causing an estimated 500 million clinical 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 in the absence of prompt recognition and urgent appropriate patient management. OBJECTIVES: 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 the general ICU of Clinica Sagrada Esperanca, 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 in the study period, we enrolled 56 patients. Forty-four (79%) were males. The mean age was 43.0 +/- 12.9. Twenty- eight (50%) were non-immune 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 h of admission to our hospital in all the cases. Twelve patients presented two or more WHO severity major criteria. Forty-one patients were treated with quinine and twelve with artemether. Nineteen patients (34%) required ventilatory support, 20 (36%) intermittent hemodialysis and 12 (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. 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 (Table 1). Table presented.