Managing malaria in the intensive care unit

Abstract

The number of people travelling to malaria-endemic countries continues to increase, and malaria remains the commonest cause of serious imported infection in non-endemic areas. Severe malaria, mostly caused by Plasmodium falciparum, often requires intensive care unit (ICU) admission and can be complicated by cerebral malaria, respiratory distress, acute kidney injury, bleeding complications, and co-infection. The mortality from imported malaria remains significant. This article reviews the manifestations, complications and principles of management of severe malaria as relevant to critical care clinicians, incorporating recent studies of anti-malarial and adjunctive treatment. Effective management of severe malaria includes prompt diagnosis and early institution of effective anti-malarial therapy, recognition of complications, and appropriate supportive management in an ICU. All cases should be discussed with a specialist unit and transfer of the patient considered.

Plasmodium Falciparum Malaria and Severe Dengue Coinfection in a Pulmonary Tuberculosis Patient: Case Report and Literature Review

“…These pathologies may manifest severely with target organ injury. In the case of infection by Plasmodium falciparum, this generates the expression of erythrocyte membrane protein of P. falciparum type 1 (Pfemp1), which binds the erythrocyte to the endothelial wall, specifically to the endothelial receptor of protein C (EPCR), generating capillary leakage as well as additional release of proinfalmatory cytokines type TNFalpha, and IL1, and increased expression of ICAM-1 [13]. On the other hand, severe dengue coinfection is also implicated in hypovolemic shock with similar molecular mechanisms with overexpression of TNFalpha, IL6, IL8, IL10, IL12, macrophage migration inhibitory factor, NS1 protein and extracellular matrix metalloproteinases.…”

Malaria grave en unidad de cuidados intensivos: Reporte de un caso de una especie no endémica en Norte de Santander, Colombia

“…La anemia malárica grave se observa principalmente en las zonas endémicas; solo una serie de paludismo importado informó a los pacientes que presentaban anemia grave según la definición de la OMS (23). La trombocitopenia refractaria del paciente fue un marcador para mortalidad importante, esto se contrasta con la literatura donde existe una fuerte asociación con la duración prolongada de la hospitalización, el aumento de la necesidad de cuidados intensivos y el aumento de la mortalidad (24).…”

Management of infections in critically ill returning travellers in the intensive care unit—II: clinical syndromes and special considerations in immunocompromised patients

“…Standard smear microscopy or culture are used for diagnosis, or rapid PCR if available (GeneXpert MTB/RIF), which has been shown to have increased sensitivity and shorten the time to treatment. 41 Where there is a high clinical suspicion of TB, empiric therapy should be initiated after adequate sampling has been obtained, particularly in the case of life-threatening or disseminated infection. Initial therapy with four drugs (isoniazid, rifampicin, pyrazinamide, and ethambutol) is generally recommended where there is a low prevalence of resistance, and depending on the patient's origin and the results of the rapid detection of rpoB gene mutations.…”

“…Malaria, which is a frequent travel-related disease, may also lead to ARDS in severely affected patients. 41 Increased alveolar capillary permeability may result in pulmonary oedema and respiratory failure either at presentation or after treatment. Pregnant women are particularly at risk.…”