[Adult respiratory distress symptom during Plasmodium falciparum malaria]

We present a typical case of adult respiratory distress syndrome (ARDS) occurring during infection with Plasmodium falciparum, in a nonimmune adult. The patient recovered after treatment.

A 63-year-old man who had traveled in Kenya without malaria prophylaxis came to the hospital after 72 hours of fever on his return. On admission, the blood smear revealed severe P. falciparum parasitemia (45%), thrombopenia (4000/mm3), disseminated intravascular coagulation, and hepatic dysfunction. He was treated with intravenous quinine, and the initial course was favorable. On day 4, his parasitemia resolved, but he developed dyspnea with hypoxemia and required mechanical ventilation. Chest radiography showed bilateral diffuse infiltrate. Low central venous and pulmonary artery occlusion pressure confirmed ARDS. Bacteriological testing remained negative. Secondary course was favorable: he was extubated on day 10 and discharged on day 13.

During the first five days of treatment for severe or multisystemic P. falciparum malaria, patients have a substantial risk of ARDS. This case illustrates the principal predisposing factors: severe parasitemia, hypoalbuminemia and fluid overload; hypoglycemia and lactic acidosis are also common.

Physicians caring for patients with malaria must anticipate the possible onset of complications, including ARDS.