Factors contributing to the prognosis of falciparum malaria

Factors contributing to the poor outcome of imported falciparum malaria in adult patients were investigated and following conclusions were drawn. 1) In the case of primarily non-immune patients, a catastrophic course of the disease was precipitated when the inception of treatment was delayed beyond 6 days after the onset of illness. Nine fatal and 3 moribund cases presently reported fell in this category. However, there were exceptional cases who made an uneventful recovery, despite the delay in starting treatment, apparently due to appropriate treatment taken immediately upon confirmation of the grave situation. 2) The group of fatal and moribund cases usually had higher parasite and lower thrombocyte counts that the groups of patients who ran a favorable course. Exceptional cases were also seen: a moribund or a fatal case with a rather low parasite count or a satisfactorily recovered case with a high initial parasite count. 3) Abnormal kidney function was seen in all the fatal and moribund cases while the incidence was low or nil in the patients who ran a favorable course. 4) The patients with a past history of malaria or in recrudescence usually ran a smooth course despite the delay in the inception of treatment which was initiated beyond the second week of illness.