Severe imported malaria in an intensive care unit: A case series

Complicated malaria is a medical emergency with a high mortality if untreated.

To describe the clinical spectrum, treatment practices and outcome of severe malaria cases admitted to an intensive care unit.

Thirteen severe malaria cases admitted to the ICU over a 6 years period (2012 - October 2018) were included. The data was retrospectively extracted from the hospital patient data management system.

Nine patients had P. falciparum malaria, three had P.Vivax, and one had both. Only one had received malarial chemoprophylaxis. The median time of attending to medical health facility after symptoms started was 7 days (range: 2-21 days). All cases responded to antimalarial therapy and supportive management. Complications included shock 54%, kidney failure 38%, respiratory failure 69%, cerebral malaria 61%, hypoglycemia 23%, coagulation derangement 8%, and acidosis 23%. There were no fatal outcomes but one case had permanent brain damage and the rest recovered completely.

The median treatment delay of seven days explains why these patients ended in intensive care with multiple symptoms of severe malaria and often multiorgan failure. Pretravel advice and use of malaria chemoprophylaxis when visiting high risk areas would probably have prevented infection and timely attendance to healthcare once symptomatic would have reduced the morbidity associated with infection, reduced length of stay in hospital and hence resources.