[Severe and complicated malaria]

Area of Science:

• Infectious Diseases
• Tropical Medicine
• Parasitology

Background:

• Severe malaria accounts for approximately 15% of annual malaria cases in France.
• Plasmodium falciparum is the primary cause of severe malaria, leading to complications like cerebral malaria and multi-organ failure.
• High mortality rates in severe malaria are linked to neurological involvement, shock, respiratory distress, metabolic acidosis, and hyperlactatemia.

Purpose of the Study:

• To outline the diagnosis and management of severe malaria.
• To highlight biological markers indicative of disease severity.
• To emphasize the importance of early treatment and monitoring for complications.

Main Methods:

• Diagnosis involves parasitological assessment and biological evaluation for severity criteria.
• Treatment for severe malaria, including in children, adults, and pregnant women, is initiated urgently with intravenous artesunate.
• Management of multi-organ failure requires intensive care unit (ICU) admission.

Main Results:

• Mortality from severe malaria in France is less than 5%.
• Delayed hemolytic anemia, occurring 10 days to 3 weeks post-treatment, affects about 15% of patients.
• Neurological involvement, circulatory shock, respiratory distress, metabolic acidosis, and hyperlactatemia are strong predictors of mortality.

Conclusions:

• Severe malaria is a systemic parasitic disease with significant mortality risk, particularly with P. falciparum.
• Intravenous artesunate is the current standard treatment, necessitating urgent administration.
• Post-treatment monitoring for delayed hemolytic anemia is crucial for patient recovery.