ISSN:
1432-1238
Keywords:
Key wordsPlasmodium falciparum
;
Malaria
;
Cerebral malaria
;
Shock
;
Bacteremia
;
Pneumonia
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
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.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s001340050396
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