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[Fatal pulmonary edema in a pernicious malaria attack]
B Rioult1, J B Mérit, N Varache
1Département d'Anesthésie-Réanimation, Centre Hospitalier, La Roche-sur-Yon.
Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1990
Summary
Cerebral malaria complicated by adult respiratory distress syndrome (ARDS) in a 40-year-old woman led to fatal hypoxia. Early fluid overload avoidance and parenteral quinine are crucial for managing severe malaria cases.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pulmonology
Background:
- Cerebral malaria is a severe complication of Plasmodium falciparum infection.
- Adult Respiratory Distress Syndrome (ARDS) can arise as a complication of severe malaria.
- Prompt diagnosis and management are critical for patient outcomes.
Observation:
- A 40-year-old female presented with cerebral malaria and ARDS, admitted to ICU in a coma (Glasgow score 5).
- Initial high Plasmodium falciparum parasitaemia (50%) and subsequent development of hypoxia, coagulopathy, and non-cardiogenic pulmonary edema were observed.
- Despite intravenous quinine, symptomatic treatment, and blood transfusion, the patient's condition deteriorated, leading to death on day 15.
Findings:
- The case highlights the severe progression of cerebral malaria complicated by ARDS, characterized by high parasitaemia, hypoxemia, and hemodynamic instability.
- Findings suggest a potential link between increased capillary permeability and malaria-induced ARDS.
- Consumption coagulopathy, including low prothrombin, elevated fibrin degradation products, and thrombocytopenia, was evident.
Implications:
- Parenteral quinine is essential for rapid schizonticidal activity in severe malaria.
- Avoiding initial fluid overload may be critical in managing malaria-associated ARDS.
- Exchange transfusion warrants further investigation as an adjunct therapy for severe malaria.