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[Severe malaria in children in intensive care. National survey 1990-1995]
F Hay1, J M Tréluyer, D Orbach
1Service de réanimation polyvalente pédiatrique, hôpital Necker-Enfants-malades, France.
Insights
Severe malaria in children, often imported, has a poor prognosis despite treatment. Early diagnosis and quinine loading doses are crucial for better outcomes in pediatric intensive care units.
Area of Science:
- Tropical Medicine
- Pediatric Intensive Care
- Infectious Diseases
Context:
- Severe malaria, a complication of Plasmodium falciparum, causes over a million child deaths annually.
- Pediatric intensive care units (PICUs) manage severe malaria cases, often imported from endemic regions.
Purpose:
- To evaluate the occurrence, mortality, morbidity, and treatment of severe malaria in French PICUs.
- To assess the effectiveness of current management strategies for severe pediatric malaria.
Summary:
- A survey of 15 severe malaria cases (1990-1995) in French PICUs revealed delayed diagnoses.
- All patients received quinine; five had loading doses. One child died, and one experienced neurological sequelae.
- Despite management improvements, severe malaria prognosis remains poor, highlighting the need for rapid intervention.
Impact:
- Emphasizes the critical need for prompt diagnosis and treatment, including quinine loading doses, for severe malaria.
- Informs clinical practice and guidelines for managing severe pediatric malaria in non-endemic settings.
- Contributes to understanding the challenges and outcomes of severe malaria in European PICUs.
Background:
Severe malaria is a frequent complication of Plasmodium falciparum infections. More than one million children die of malaria each year.
Material And Methods:
A French survey was carried out on 15 cases admitted to pediatric intensive care units between 1990 and 1995. The aim of this work was to evaluate the occurrence, mortality, morbidity and treatment of severe malaria in French intensive care units.
Results:
All cases were imported from Africa except one case of airport malaria. Diagnosis of many of these cases was delayed. All cases were treated with quinine, and five children received a loading dose. One child died and one has neurological sequelae.
Discussion:
Despite improvement in management, the prognosis of severe malaria remains poor. With reference to the literature, we propose management of severe malaria, emphasizing the necessity of a rapid effect with a loading dose of quinine.
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