Algid malaria treated with early goal-directed therapy

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Tropical Medicine

Background:

• Severe malaria, particularly algid malaria presenting with circulatory shock, is increasingly encountered in non-endemic regions.
• The optimal fluid resuscitation strategy for algid malaria remains undefined, with some advocating for volume restriction to prevent edema.

Observation:

• A young woman with imported Plasmodium falciparum malaria presented with fever, hypotension, and malaise.
• She received 5.5 L of normal saline and norepinephrine for resuscitation, alongside antimalarial therapy and antibiotics.

Findings:

• The patient experienced rapid reversal of circulatory shock and clearance of parasitemia within 48 hours.
• Successful management was achieved with aggressive fluid resuscitation, hemodynamic optimization, and early treatment.

Implications:

• This case challenges the conventional approach of cautious fluid resuscitation in algid malaria.
• Further research, including case series and prospective trials, is needed to establish definitive fluid resuscitation guidelines for severe malaria with shock.