[Exchange transfusion in cases of falciparum malaria]

Malaria is diagnosed in 50-70 patients each year in Norway. Severe malarial infection with cerebral involvement as well as hypoglycaemia, circulatory collapse and renal failure is often difficult to diagnose since the condition is only rarely seen in Scandinavia. This report describes a 49 year old seaman, who was admitted to hospital with a clinical picture of sepsis with multiorgan involvement including cerebral affection. Subsequently, it turned out that the patient had a severe infection with Plasmodium falciparum, involving more than 50 per cent of the red blood cells. Despite being comatose for one week with repeated attacks of grand mal type, and requiring 11 days mechanical ventilation plus dialysis for 4 weeks, he recovered uneventfully and was dismissed from hospital with only minor neurological sequelae. Even severe malaria with cerebral involvement can result in full restitution if the diagnosis is made early and exchange transfusion plus treatment with relevant drugs are instituted promptly.