Shock complicating severe falciparum malaria in European adults

Abstract

Objective: To study adult patients with severe falciparum malaria who developed shock. Design: Retrospective study from 1987 to 1993. Setting: Medical intensive care unit in a university hospital. Patients: 14 patients admitted with severe falciparum malaria who developed shock. All received intravenous quinine. Measurements and results: The mean Simplified Acute Physiology Score II was 59.5 ± 7.1; 2.6 ± 0.4 criteria defining severe disease were present on admission in 12 patients; and initial parasitemia was 21 ± 6 %. Twelve patients received inotropic drugs. Pulmonary artery catheterization showed the following results in 7 patients: mean arterial pressure 57 ± 4 mmHg; pulmonary artery occlusion pressure 11 ± 1 mmHg; cardiac index 5.5 ± 0.9 l · min⁻¹· m⁻²; and systemic vascular resistance index 783 ± 122 dyne · s · cm⁻⁵· m⁻². Seven patients had evidence of bacterial infection at the time of shock. Of the 7 deaths (50 %), 5 were due to shock, with documented bacterial infection in all patients and persistent parasitemia in 4. Conclusions: Shock complicating severe falciparum malaria in adults is associated with peripheral vasodilation and carries a poor prognosis. In falciparum malaria with shock, bacterial coinfection should be suspected immediately and treated empirically with broad-spectrum antibiotics. Nevertheless, Plasmodium falciparum may contribute directly or indirectly to the onset of shock.