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Updated: Jun 20, 2026
Protocol for Plasmodium falciparum Infections in Mosquitoes and Infection Phenotype Determination
Published on: July 4, 2007
Retrospective study of imported falciparum malaria in French paediatric intensive care units
Justine Lanneaux1, Stéphane Dauger1, Luu-Ly Pham2
1Department of Paediatric Intensive care, AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Objective:
The World Health Organization (WHO) severity criteria for paediatric Plasmodium falciparum (Pf) malaria are based on studies in countries of endemic malaria. The relevance of these criteria for other countries remains unclear. We assessed the relevance of these criteria in an industrialised country.
Design:
Retrospective case-control study.
Setting:
Eight French university hospitals, from 2006 to 2012.
Patients:
Children with Pf malaria admitted to paediatric intensive care units (cases: n=55) or paediatric emergency departments (controls: n=110).
Main Outcome Measures:
Descriptive analysis of WHO severity criteria and major interventions (mechanical ventilation, blood transfusion, fluid challenge, treatment of cerebral oedema, renal replacement therapy). Thresholds were set by receiver operating characteristics curve analysis.
Results:
Altered consciousness (71% vs 5%), shock (24% vs 1%), renal failure (20% vs 1%), anaemia <50 g/L (7% vs 2%), acidosis (38% vs 0%), bilirubin level >50 µmol/L (25% vs 8%) and parasitaemia >10% (30% vs 8%) were more frequent in cases (p<0.01). All these criteria were associated with major interventions (p<0.001). Respiratory distress (six cases), and hypoglycaemia (two cases) were infrequent. Thrombocytopenia <50 000/mm3 (46% vs 7%) and anaemia (haemoglobin concentration <70 g/L (41% vs 13%)) were more frequent in cases (p<0.0001).
Conclusions:
The WHO severity criteria for paediatric Pf malaria are relevant for countries without endemic malaria. The infrequent but severe complications also provide a timely reminder of the morbidity and mortality associated with this condition worldwide. In non-endemic countries haemoglobin <70 g/L and platelet count <50 000/mm3 could be used as additional criteria to identify children needing high level of care.
Insights
The World Health Organization (WHO) malaria severity criteria are relevant for children in non-endemic countries. Additional criteria like low hemoglobin and platelet counts can help identify severe pediatric Plasmodium falciparum malaria cases.
Area of Science:
- Pediatric infectious diseases
- Global health
- Clinical diagnostics
Background:
- Paediatric Plasmodium falciparum (Pf) malaria severity criteria by the WHO are based on endemic regions.
- Their applicability in non-endemic, industrialized countries is not well-established.
- Assessing these criteria in diverse settings is crucial for accurate diagnosis and management.
Purpose of the Study:
- To evaluate the relevance of WHO severity criteria for paediatric Pf malaria in an industrialized nation.
- To determine if existing criteria effectively identify children requiring intensive care.
- To explore potential additional criteria for improved risk stratification.
Main Methods:
- A retrospective case-control study was conducted across eight French university hospitals from 2006 to 2012.
- Cases included children with Pf malaria admitted to paediatric intensive care units (n=55).
- Controls included children with Pf malaria admitted to paediatric emergency departments (n=110).
- Descriptive analysis of WHO severity criteria and major interventions was performed, with thresholds determined by receiver operating characteristics curve analysis.
Main Results:
- Altered consciousness, shock, renal failure, acidosis, and high bilirubin/parasitaemia levels were significantly more frequent in severe cases (p<0.01).
- Respiratory distress and hypoglycemia were infrequent complications.
- Severe thrombocytopenia (platelet count <50,000/mm³) and anemia (hemoglobin <70 g/L) were more prevalent in severe cases (p<0.0001).
Conclusions:
- WHO severity criteria for paediatric Pf malaria are relevant even in non-endemic countries.
- Severe complications underscore the global morbidity and mortality associated with malaria.
- Hemoglobin <70 g/L and platelet count <50,000/mm³ may serve as valuable additional criteria for identifying high-risk children in non-endemic settings.
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